Pharmacokinetic Basis for Oral Perioperative Prophylaxis with Ofloxacin in General Surgery

Abstract

Background: Peroperative prophylaxis is recommended to be administered intravenously which, compared to oral prophylaxis, is more expensive. However, pharmacokinetic data on oral perioperative prophylaxis in patients with preoperative surgical and anesthesiological preparation are not available.

Patients and Methods: 40 patients with open hernial repair or cholecystectomy (low-risk group), colonic or pancreatic resection (high-risk group) received a standard single-dose perioperative prophylaxis with 4.5 g mezlocillin and 0.5 g metronidazole intravenously in addition to 400 mg ofloxacin orally 2 h prior to surgery. Antibiotic concentrations were measured perioperatively and pharmacokinetic data calculated.

Results: Serum and tissue concentrations of ofloxacin were above the MIC₉₀ of the potential bacterial spectrum for surgical infection throughout the entire operation.

Pharmacokinetic data were not influenced by preoperative surgical or anesthesiological preparation.

Conclusion: Tissue and serum concentrations and the antibacterial spectrum of orally administered ofloxacin suggest effective protection against perioperative infection. Pharmacokinetic data confirm that oral ofloxacin may be used effectively as single-dose perioperative antibiotic prophylaxis. Since there are no clinical data comparing oral and intravenous single-dose prophylaxis, a prospective randomized clinical trial should be performed.