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Pharmacokinetics of Topical and Intravenous Cefazolin in Patients with Clean Surgical Wounds

White, Raleigh R. IV M.D.; Pitzer, Keith D. M.D.; Fader, Robert C. Ph.D.; Rajab, M Hasan Ph.D., M.S., M.P.H.; Song, Juhee Ph.D.

Plastic and Reconstructive Surgery: December 2008 - Volume 122 - Issue 6 - p 1773-1779
doi: 10.1097/PRS.0b013e31818d5899
Reconstructive: Trunk: Original Articles

Background: Surgical-site infection is a common postoperative nosocomial infection. Surgeons frequently treat operative patients with protective antibiotics and often choose cefazolin as the drug. Treatment schemes include both preoperative intravenous dosing and intraoperative dosing by irrigation. This study was designed to measure cefazolin concentrations both in serum and in wound drain fluid after intravenous dosing and after irrigation.

Methods: The authors conducted an institutional review board–approved study involving randomized allocation of breast reduction patients to group 1 (preoperative intravenous dosing) or group 2 (intraoperative dosing by irrigation). Each patient had serum and wound drainage specimens measured over time for cefazolin concentrations. Cefazolin dosing was based on preparations commonly used in the authors’ hospital. Results from 24 patients are reported.

Results: Patients treated by conventional preoperative intravenous dosing displayed the expected serum degradation curve. These patients also demonstrated wound drainage concentrations (peak, 22.49 μg/ml) for approximately 4 to 5 hours. Measured concentrations were above the minimum therapeutic concentration (8 μg/ml) for Staphylococcus aureus. Patients treated by wound irrigation also demonstrated serum concentrations above minimum therapeutic concentration. In addition, these patients’ wound drain fluid demonstrated very high cefazolin concentrations (peak, 4185.93 μg/ml), which remained high for 24 hours.

Conclusions: Protective cefazolin concentrations in the wound can be achieved by both intravenous and irrigation delivery. Wound irrigation produces higher concentrations for longer periods of time.

Temple, Texas

From the Departments of Surgery, Pathology, and Biostatistics, Scott and White Memorial Hospital and Clinic; Scott, Sherwood, and Brindley Foundation; and Texas A & M University System Health Science Center College of Medicine.

Received for publication February 12, 2008; accepted May 1, 2008.

Presented at 86th Annual Meeting of the American Association of Plastic Surgeons, in Coeur d’Alene, Idaho, May 19 through 23, 2007; the Texas Society of Plastic Surgeons, in Cisco, Texas, May 23, 2006; and the Texas Surgical Society, in Waco, Texas, October 6 through 9, 2006.

Disclosures: All authors are employed by the Scott and White Healthcare System and have no personal financial interest in this project. The antibiotic, cefazolin, was ordered from the Scott and White hospital pharmacy in the patient care continuum. No financial support was sought or given by the makers of cefazolin.

Raleigh R. White IV, M.D.; Division of Plastic Surgery; Scott and White Memorial Hospital; 2401 South 31st Street; Temple, Texas 76508;

©2008American Society of Plastic Surgeons