Advertisement

Comparative study of systemic intravenous and regional intravenous administration of prophylactic antibiotic in lower extremity orthopaedic surgery

  • Stefanos TsourvakasEmail author
  • Christos Alexandropoulos
  • Cleanthes Efstathiou
  • George Savidis
  • Helen Polizou
  • Konstantinos Kesoglou
Original Article

Abstract

In this study, we describe a technique for the delivery of regional antibiotic prophylaxis in patients undergoing reconstructive surgery in the lower extremities and compare the tissue antibiotic concentrations achieved by this technique with those achieved by standard systemic intravenous prophylaxis. The efficacy of a regional route for antibiotic prophylaxis in lower extremity orthopaedic procedures was investigated in 20 patients and compared with the standard systemic intravenous method in 45 patients using a second generation cephalosporin (ceforanide). The antibiotic (2 g) was given intravenously as the standard systemic prophylaxis at different intervals (10, 20 min and 2 h) before tourniquet inflation. The same dose of antibiotic was injected intravenously into the ipsilateral foot after the inflation of tourniquet. Samples of bone, fat and muscle were collected during the operation and assayed for ceforanide by a microbiological method. None of the patients experienced local or systemic adverse following the regional administration of ceforanide, or infections during the postoperative and follow-up period. Peak tissue levels of the systemic antibiotic were observed when the antibiotic was given 20 min before tourniquet inflation. For all tissue samples, the antibiotic levels were significantly higher when the antibiotic was given regionally (P < 0.001). The results of this study suggest that the regional administration could be a useful route for prophylaxis during lower extremity orthopaedic procedures when they are carried out under tourniquet control.

Keywords

Antibiotics Cephalosporin Tourniquet Regional administration 

Notes

Acknowledgments

No funds were received in support this study.

Conflict of interest statement

The authors of this manuscript have chosen not to furnish Ejost and its readers with information regarding any relationship that might exist between a commercial party and material contained in this manuscript that might represent a potential conflict of interest. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

References

  1. 1.
    Craig W (1998) Pharmacokinetic/pharmacodynamic parameters: rationale for antibacterial dosing of mice and men. Clin Infect Dis 26:1–12PubMedCrossRefGoogle Scholar
  2. 2.
    De Lalla F, Viola R, Pellizzer G, Lazzarini L, Tramarin A, Fabris P (2000) Regional prophylaxis with teicoplanin in monolateral or bilateral total knee replacement: an open study. Antimicrob Agents Chemother 44(2):316–319PubMedCrossRefGoogle Scholar
  3. 3.
    Dounis E, Tsourvakas S, Kalivas L, Giamarellou H (1995) Effect of time interval on tissue concentrations of cephalosporins after tourniquet inflation. Acta Orthop Scandinavica 66(2):158–160CrossRefGoogle Scholar
  4. 4.
    Dounis E, Tsourvakas S, Kalivas L, Tzivelekis P, Papakalou E, Giamarellou H (1995) Regional intravenous versus systemic intravenous prophylactic administration of third generation cephalosporins (ceftazidime and ceftriaxone) in elective foot surgery. Foot 5:133–136CrossRefGoogle Scholar
  5. 5.
    Garrod LP, Lambert HP, O’Grady F (1981) Antibiotic and chemotherapy. Churchill-Livingstone, Edinburgh, pp 679–691Google Scholar
  6. 6.
    Hanssen AD, Osmon DR (1999) The use of prophylactic antimicrobial agents during and after hip arthroplasty. Clin Orthop 369:124–138PubMedCrossRefGoogle Scholar
  7. 7.
    Hoddinott C, Lovering AM, Fernando HC, Dixon JH, Reeves DS (1990) Determination of bone and fat concentrations following systemic cefamandole and regional cefuroxime administration in patients undergoing knee arthroplasty. J Antimicrob Chemother 26:823–829PubMedCrossRefGoogle Scholar
  8. 8.
    Johnson DP (1987) Antibiotic prophylaxis with cefuroxime in arthroplasty of the knee. J Bone Joint Surg 69-B:787–789Google Scholar
  9. 9.
    Joshi BB, Chaudhari SS (1971) Intravenous regional antibiotic perfusion as prophylaxis against infection in injured hands. Indian J Med Scie 25:392–394Google Scholar
  10. 10.
    Lazzarini L, Novelli A, Marzano N, Timillero L, Fallani S, Viola R, De Lalla F (2003) Regional and systemic prophylaxis with teicoplanin in total knee arthroplasty. A tissue penetration study. J Arthroplasty 18(3):342–346. doi: 10.1054/arth.2003.50053 PubMedCrossRefGoogle Scholar
  11. 11.
    Lovering AM, Perez J, Bowker KE, Reeves DS, McGowan AP, Bannister G (1997) A comparison of the penetration of cefuroxime and cefamandole into bone, fat and haematoma fluid in patients undergoing total hip replacement. J Antimicrob Chemother 40:99–104PubMedCrossRefGoogle Scholar
  12. 12.
    Miller SB, Harper PW, Hughes SJ, Sonnabend HD, Walsh WR (2004) Regional antibiotic prophylaxis in elbow surgery J. Shoulder Elbow Surg 13:57–59. doi: 10.1016/S1058-2746(03)00219-2 CrossRefGoogle Scholar
  13. 13.
    Papaioannou N, Kalivas L, Kalavritinos J, Tsourvakas S (1994) Tissue concentrations of third generation cephalosporins (ceftazidime and ceftriaxone) in lower extremity tissues using a tourniquet. Arch Orthop Trauma Surg 113:167–169PubMedCrossRefGoogle Scholar
  14. 14.
    Salam AA, Eyres KS, Cleary J, Sayed HH (1991) The use of a tourniquet when plating tibial fractures. J Bone Joint Surg 73-B:86–87Google Scholar
  15. 15.
    Scaglione F, De Martini G, Peretto L, Ghezzi R, Baratelli M, Arcidiacono MM, Fraschini F (1997) Pharmacokinetic study of ceftazidime and ceftriaxone in sera and bones of patients undergoing hip arthroplasty. Antimicrob Agents Chemother 41(10):2292–2294PubMedGoogle Scholar
  16. 16.
    Seddon M, Wise R, Gillet AP, Livingstone R (1980) Pharmacokinetics of RO13–9904, a broad spectrum cephalosporin. Antimicrob Agents Chemother 18:240–242PubMedGoogle Scholar
  17. 17.
    Sugerbaker E, McBride S (1976) Survival and regional disease control after isolation-perfusion for invasive stage I melanoma of the extremities. Cancer 37:188–198CrossRefGoogle Scholar
  18. 18.
    Vanos D, Ramamurthy S, Hoffman J (1992) Intravenous regional block using ketorolac: preliminary results in the treatment of reflex sympathetic dystrophy. Anesth Analg 74:139–141PubMedCrossRefGoogle Scholar
  19. 19.
    Williams D, Gustilo R, Beverly RG, Kind A (1983) Bone and serum concentrations of five cephalosporin drugs. Relevance to prophylaxis and treatment in orthopaedic surgery. Clin Orthop Rel Res 179:253–265Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Stefanos Tsourvakas
    • 1
    Email author
  • Christos Alexandropoulos
    • 1
  • Cleanthes Efstathiou
    • 1
  • George Savidis
    • 2
  • Helen Polizou
    • 2
  • Konstantinos Kesoglou
    • 2
  1. 1.Orthopaedic DepartmentGeneral Hospital of TrikalaTrikalaGreece
  2. 2.Department of AnaesthesiologyGeneral Hospital of TrikalaTrikalaGreece

Personalised recommendations