Randomized comparison of cefamandole, cefazolin, and cefuroxime prophylaxis in open-heart surgery

Abstract

A total of 337 patients undergoing coronary artery bypass grafting or cardiac valve replacement were randomly assigned to receive cefazolin (1 g every 8 h [q8h]), cefamandole (2 g q6h), or cefuroxime (1.5 g ql2h) as an intravenous antibiotic prophylaxis. All drugs were administered within 60 min before the initial incision and were continued for 48 h postoperatively. No adverse effects related to the study drugs were observed. The percentage of patients with postoperative infection was 9% for the cefazolin group, 6% for the cefamandole group, and 5% for the cefuroxime group or 6.5% overall. There were more infection sites in patients treated with cefazolin than in those treated with cefuroxime (P = 0.05) or cefamandole (P = 0.06). Fewer wound infections ocwcurred with cefuroxime (P < 0.01) and cefamandole (P = 0.06) than with cefazolin. Analyses of the prophylactic regimens used in this study showed cefazolin and cefuroxime to be less costly than cefamandole.

Reappraisal of the antistaphylococcal activities of first-generation (narrow-spectrum) and second-generation (expanded-spectrum) cephalosporins

“…Cefazolin has been considered ideal for this purpose because of its pharmacokinetic properties and broad-spectrum antimicrobial activity. Well-designed, placebo-controlled trials have demonstrated that cefazolin reduces the incidence of postoperative wound infections in comparison with placebos in patients undergoing vascular surgery (13) and total hip replacement (11 (14,19,28). The smaller study by Meszaros and colleagues (19) can be criticized because significant differences between treatment groups were apparent only when all infections were included.…”

“…In contrast, Gentry and colleagues (9) found no differences (14,28) in which wound infection pathogens were available, the microbiology of these postoperative infections indicated that, despite prophylaxis, staphylococci continued to produce infectious complications (Table 2). S. aureus and S. epidermidis accounted for more than one-half of the wound infections among cefazolin recipients.…”

“…There were no differences in the rates of postoperative wound infections. In the two larger studies, both cefamandole and cefuroxime clearly reduced the incidence of wound infections in comparison with cefazolin (14,28).…”

Tissue and Plasma Concentrations of Antibiotic During Cardiac Surgery With Cardiopulmonary Bypass - Microdialysis Study

“…As a prophylaxis, and study drug, we used cefuroxime, because cephalosporins are frequently prescribed for prophylaxis in cardiac surgery [21][22][23] . The dosing schedules for the cephalosporins (cefuroxime) administration as recommended by the manufacture's are of general validity and can serve as a basis for prophylactic administration in general surgical interventions.…”

Relationship between cefamandole and cefuroxime activity against oxacillin-resistant Staphylococcus epidermidis and oxacillin resistance phenotype

“…Res. 35:21a, 1987) and cefuroxime have been associated with significantly fewer postoperative staphylococcal infections (11). In contrast, cefamandole has not been consistently effective against methicillin-resistant staphylococci either in experimental models of infection (6) or in clinical studies (2,4).…”