Changes of the serum antibiotic levels during open heart surgery (ceftazidim, ciprofloxacin, clindamycin)
| Autor: | Hejzlar M, Dominik J, Mand'ák J, Marsíková M, Lonská, Snítilová M, Pozlerová E, Lonský, Kubícek J |
|---|---|
| Předmět: |
medicine.medical_specialty
050402 sociology medicine.drug_class Antibiotics lcsh:Medicine Ceftazidime Intracardiac injection law.invention 03 medical and health sciences 0302 clinical medicine 0504 sociology Anti-Infective Agents law Ciprofloxacin medicine Cardiopulmonary bypass Humans Prospective Studies Coronary Artery Bypass Prospective cohort study 030203 arthritis & rheumatology Cardiopulmonary Bypass business.industry Incidence (epidemiology) Clindamycin lcsh:R 05 social sciences General Medicine Cardiac surgery Antibiotic Prophylaxis Surgery Anti-Bacterial Agents Cephalosporins Regimen surgical procedures operative Serum antibiotics concentrations business medicine.drug |
| Zdroj: | Scopus-Elsevier Acta Medica, Vol 43, Iss 1, Pp 23-27 (2000) |
| Popis: | Background: Wound, mediastinal and intracardiac infections are still very serious complications of open-heart surgey. The incidence of it is still in the range of 0.4%-5%. The aims of our study were to assess the adequacy of regimen using ceftazidim (CTZ), ciprofloxacin (CPF) and clindamycin (CLIN) as prophylactic antibiotics and to verify whether cardiopulmonary bypass (CPB) can modify the time of antibiotic serum concentrations. That is why the serum levels of them were measured during open heart procedures. Methods: The prospective study comprised 75 consequent coronary patients randomized in to three groups receiving 1 g of CTZ or 400 mg of CPF or 900 mg of CLIN i.v. with anesthesia induction. Routine coronary surgery with left internal mammary artery harvesting, moderate body hypothermic (30 °C) CPB with crystaloid cardioplegia was performed. Serum antibiotic levels were determined before application, with skin incision, prior CPB induction, after cardioplegia infusion, every 20 minutes of CPB, prior end of CPB, in time of chest closure. Conventional cylinder – plate microbiological assay was used for antibiotic levelmeasurement. Results: All serum antibiotic concentrations showed a sharp decrease immediately after starting CPB and lasted until CPB ended. After initiating of CPB after cardioplegia administration serum concentrations of CTZ (105 min after initial dose) decreased by, on average 55%, CPF (97 min) by 42% and CLIN (116 min) by 78%. Conclusion: CPB can modify the time course of antibiotic serum concentrations. The serum levels of CTZ at the end of the longest procedures were found to be below the MICs for some of the suspected pathogens. We recommend to use higher antibiotic doses for prophylaxis and to administer the second dose with protamin sulphate to obtain maximum concentration in newly formed blood clots. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|