Flucloxacillin in bone.

Abstract

SUMMARY Ten patients undergoing total hip replacement for osteoarthritis were each given intramuscular flucloxacillin about two hours preoperatively; bone and serum were sampled simultaneously at operation. Trabecular and compact bone were separated, partly dried, reduced to powders, and then extracted with buffer. The concentration of flucloxacillin in bone washings and serum was determined by well-diffusion assay. The mean concentration of flucloxacillin in serum was 8-9 mg/l, in trabecular bone washings, 1-3 mg/l, and in compact bone washings 0 9 mg/l. The amount of blood contaminating the bone washings was measured, and was calculated to account for at most 26 % of the flucloxacillin present. The significance of these findings is discussed in relation to the prophylactic use of flucloxacillin in hip replacement surgery.Although deep infection rates after total hip replacement operations are of the order of only 2 to 6% (Benson and Hughes, 1975) deep infection is a serious complication as it usually necessitates removal of the prosthesis.The commonest organisms causing deep infection are coagulase-positive and -negative staphylococci (Visuri et al., 1976), and a number of studies have been made with various prophylactic antibiotics (Ericson et al., 1973;Parsons, 1976). Lincomycin and clindamycin have the drawback of causing pseudomembraneous colitis in some patients, and fucidin, when used alone, may cause resistant organisms to emerge (Garrod et al., 1973a Specimens of marrow were aspirated from four femoral shafts after removal of the heads, and the time of aspiration was recorded for two. Aspirates from patients 4 and 9 were allowed to stand, and the supernatants were assayed for flucloxacillin; the whole aspirates from cases 1 and 10 were assayed.Packed erythrocytes of patient 7 were separated and assayed for flucloxacillin whole and after lysis by addition of a drop of saponin 2 % w/v. PREPARATION OF BONE WASHINGSThe femoral head and attached part of the femoral neck was excised and the time was noted in each case. Delay was minimised and the storage time and temperature were recorded.

Plasma and bone concentrations of cefuroxime and flucloxacillin: Oral versus parenteral administration in 20 arthroplasties

“…The bone concentrations of flucloxacillin and cefuroxime after intravenous administration measured in our study are in agreement with previous studies (Parssons et al 1978, Unsworth et al 1978, Jung and Mischkowsky 1979, Dornbush et al 1980, Holm and Larsson 1982, Kondell et al 1982, Leigh et al 1982, 1986, Sirot et al 1982, Brooks and Dent 1984, Hedstrom et al 1984, Heimdahl et al 1988, Wilson et al 1988). …”

Cefamandole Bone Diffusion in Patients Undergoing Total Hip Replacement

“…This finding agrees with previous reports on cefotaxime [13], oxacillin [14] and flucloxacillin [5], The penetration ratio was calculated with 'peak' and simultaneous blood levels. Previous workers [5,11,12] refer to simultaneous blood levels. Pharmacokinetic studies show that tissues follow a deep-compartment model [15].…”

Penetration of Amoxycillin and Clavulanic Acid into Bone

“…The problems of assaying antibiotics in bone are well known [2,7,8,12,13,[16][17][18]. Some of these investigators have made allowance for the contamination of the bone with blood, whilst others have chosen to ignore this.…”