CEFUROXIME VERSUS CEFTRIAXONE PROPHYLAXIS IN CARDIOVASCULAR-SURGERY

  • 1 January 1985
    • journal article
    • research article
    • Vol. 11  (3) , 201-205
Abstract
In a randomized, prospective study a 2-day course of cefuroxime prophylaxis (Zinacel, 1.5g every 12 h) was compared with 2-day ceftriaxone prophylaxis (Rocephin, 2g i.v. plus 1g i.v. after 24 h). To date 512 patients undergoing cardiac (n = 418) and major vascular surgery (n = 94) entered the study (258 in the cefuroxime and 254 in the ceftriaxone group). The 1-mo. lethality rate was 1.0%. The total infection rate was 4.7% (12 patients in the cefuroxime and 12 in the cefuroxime group. Septicemia occurred in 1-4% (cefuroxime n = 4; ceftriaxone n = 3) and pneumonia in 2% (5 vs. 5 patients). One patient developed diarrhea due to Clostridium difficile. Plasma concentrations of ceftriaxone were measured (HPLC [high-performance liquid chromatography] method) over the first 24 h in 110 patients undergoing cardiac surgery. Plasma concentrations 24 h post-injection were 25.4 .+-. 12.7 .mu.g/ml. Prophylaxis with either cefuroxime or ceftriaxone was highly effective. The mean plasma levels of ceftriaxone achieved are far in excess in the MIC [minimal inhibitory concentration] for the microorganisms commonly associated with infection following cardiovascular surgery, with the exception of Bacteroides and Pseudomonas. A single dose of ceftriaxone should therefore provide adequate prophylaxis for most patients undergoing major cardiovascular surgery.