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AAPS 2007 Annual Meeting, May 19 - 22, 2007, The Coeur d'Alene Resort, Coeur d'Alene, Idaho.
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Pharmacokinetics of Topical and Intravenous Antibiotics in Patients with Clean Surgical Wounds
Raleigh R. White, IV, M.D., Keith Pitzer, M.D., Robert Fader, Ph.D., Hasan Rajab, Ph.D..
TAMU College of Medicine/ Scott and White Clinic, Temple, TX, USA.

Purpose: Surgical site infection is the second most common cause of nosocomial infection, which fact leads surgeons from multiple specialties to protect patients with perioperative antibiotics administered either intravenously or by surgical site irrigation, or both. Systemic absorption of topical perioperative antibiotics has been documented previously. However, there is no information from human studies that we can find on the concentration of antibiotic from surgical site drainage following either intravenous or topical perioperative antibiotic administration. This study measures these concentrations.
Methods: This is an open-label, randomized, prospective study conducted as an IRB approved investigation at Scott and White Hospital. We chose reduction mammoplasty patients for the study cohort for two reasons. Firstly, we routinely use a drain in each surgical site. Secondly, we routinely give these patients perioperative antibiotics. We chose Cefazolin in doses commonly used in our hospital for both intravenous (one gram immediately preoperatively) and topical application (two grams in 250cc saline irrigation fluid for each surgical site). Twenty three patients were consented to participate, and eighteen sets of complete data (36 surgical sites) were available for analysis. Group I patients (12) recieved intravenous cefazolin and saline surgical site irrigations. Group 2 patients (6) recieved cefazolin wound irrigations. For each patient we measured serum samples and bilateral drain fluid at 15, 30, and 60 minutes and 2,3,4,and 5 hours post antibiotic administration. Antibiotic concentrations were measured by the method of Bennett using agar plates prepared with Staph Aureus. Data was analyzed by standard statistical methods.
Results: For the intravenous group I patients a typical serum distribution curve was measured as expected (graph 1). A similar serum curve was measured for the surgical site irrigation patients (graph 1). Dramatic differences in antibiotic concentrations were measured in drain fluid concentrations with the irrigation group II patients showing antibiotic levels 100 times higher than that of intravenous group I patients. These differences were sustained over the five hour study period (graph 2). Graphs attached.
Conclusions: These data document previously unreported antibiotic concentrations in surgical site drain fluid after both intravenous and wound irrigation antibiotic delivery. Intravenous delivery results in measurable levels of antibiotic in drain fluid over five hours. The very high surgical site concentrations achieved and sustained in Group II may indicate that irrigation is an effective method of providing perioperative antibiotic protection in selected operations. In this small study no patient developed infection or any other complications.
PowerPoint Presentation Figure 1

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