Résumé
La fréquence des discites survenant après discectomie varie de 0,75% à 3,0% et nous pensons qu'elle pourrait être encore plus réduite si l'on protégeait le geste chirurgical par une antibiothérapie prophylactique pénètrant le tissu discal et de spectre approprié. Une étude prospective a été réalisée chez vingt patients subissant une discectomie lombaire de routine. Dix patients ont reçu en préopératoire 1,2 g d'Augmentin et dix autres 1,5 g de Céfuroxime. Chez huit patients, des fragments discaux exclus ont été analysés et dans la plupart d'entre eux on a trouvé un taux de médicament supérieur à celui retrouvé dans le matériel discal en place: les laisons en sont discutées. Nous pensons en conclusion que l'Augmentin pénètre le matériel discal endommagé de manjère limitée, mais le Céfuroxime y atteint des taux efficaces contre les germes pathogènes le plus communément impliqués dans le tissue de discité et représente un choix raisonnable dans l'antibiothérapie prophylactique de la chirurgie discale lombaire.
Summary
The incidence of discitis following discectomy is reported at between 0.75% and 3.0%. We believe this rate could be reduced if an antibiotic that penetrated the disc tissue with an appropriate spectrum were to be given prophylactically to cover surgery. A prospective study of 20 patients undergoing routine lumbar discectomy was performed. Ten patients received Augmentin 1 2 g and ten received cefuroxime 1.5 g pre-operatively. In eight patients sequestrated disc fragments were analysed, and the majority were found to have drug levels higher than in the attached disc material; the reasons for this are discussed. We conclude that Augmentin penetrates damaged disc material to a limited extent, but cefuroxime achieves levels effective against the most commonly implicated pathogens in discitis tissue and is a rational choice of antibiotic for prophylaxis during lumbar discectomy.
This is a preview of subscription content, log in via an institution to check access.
References
Cooper CE, Slocombe B, Sutherland R (1990) The ability of low concentrations of clavulanic acid to enhance the activity of amoxycillin against beta lactamase producing Staphylococcus aureus. Poster at 7th Mediterranean Congress of Chemotherapy, May 1990, Barcelona, Spain
Fernand R, Casey KL (1986) Post laminectomy disc space infection — a review of the literature and report of three cases. Clin Orthop Rel Res 209:215–218
Gibson MJ, Karpinski MRK, Slack RCB, Cowlishaw WA, Webb JK (1987) The penetration of antibiotics into the normal intervertebral disc. J Bone Joint Surg [Br] 69:784–789
Howe CW, Masston AT (1962) A study on sources of post operative staphylococcal infection. Surg Gynaecol Obstet 115:266–275
Lindholm TS, Pylkkanen P (1982) Discitis following removal of intervertebral disc. Spine 7:618–662
Pilgaard S, Aarhus N (1969) Discitis following removal of lumbar intervertebral disc. J Bone Joint Surg [Am] 51:713–716
Schofferman L, Schofferman J, Zucherman J, Gunthorpe H, Hsu K, Pecetti G, Goldwaite N, White A (1989) Occult infections causing persistent low back pain. Spine 14:417–419
Staniforth DH, Jackson D, Horton R, Davies B (1984) Parenteral Augmentin: pharmacokinetics. Int J Clin Pharmacol Ther Toxicol 22:430–434
Taylor TFK, Dooley BJ (1978) Antibiotics in the management of post operative disc space infections. Aust N Z J Surg 48:74–77
Thibodeau AA (1968) A closed space infection following removal of intervertebral disc. Symposium: complications of lumbar disc surgery. J Bone Joint Surg [Am] 50:400–410
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Housden, P.L., Sullivan, M.F. Do Augmentin or cefuroxime reach effective levels in lumbar vertebral discs when used prophylactically for discectomy?. Eur Spine J 2, 145–148 (1993). https://doi.org/10.1007/BF00301412
Issue Date:
DOI: https://doi.org/10.1007/BF00301412