Regional and systemic prophylaxis with teicoplanin in monolateral and bilateral total knee replacement procedures: study of pharmacokinetics and tissue penetration

Abstract

Twenty-four patients undergoing monolateral or bilateral total knee replacement (TKR) procedures were randomized to receive teicoplanin (T) either systemically or regionally. Subjects scheduled for systemic prophylaxis and undergoing monolateral (six patients) or bilateral (five patients) TKR received a single 800-mg dose of T in 100 ml of saline as a 5-min infusion into a forearm vein 2.5 h before surgery. For regional prophylaxis, patients undergoing monolateral surgery (eight subjects) received 400 mg of T in 100 ml of saline as a 5-min infusion into a foot vein of the leg to be operated on immediately after the tourniquet was inflated.For the five patients scheduled for bilateral operation and regional prophylaxis, the administration of T was also repeated for the second knee operation. The tourniquet, as the standard TKR surgical technique, was inflated to 400 mm Hg (c. 50 kPa) in all 24 patients immediately before the beginning of surgery and kept in place for the duration of the operation. Samples of serum, bone, skin, synovia, and subcutaneous tissue were collected at timed intervals during surgery. They were microbiologically assayed for T by using Bacilus subtilis as the test organism. Overall, the mean T concentrations obtained with regional route prophylaxis were found to be 2 to 10 times higher than those achieved following systemic prophylaxis. Moreover, peak levels in different tissues after regional prophylaxis were significantly higher (P < 0.05). None of the patients experienced adverse effects due to regional or systemic T administration; no prosthetic or wound infections were observed in the

Higher Cefazolin Concentrations with Intraosseous Regional Prophylaxis in TKA

“…de Lalla et al [8] RCT in 24 patients comparing 800 mg IV teicoplanin 2.5 hours preoperatively versus 400 mg teicoplanin through the foot vein…”

“…Some authors have used a foot vein cannula for administering prophylactic antibiotics in TKA. With this approach, substantially higher tissue concentrations of antibiotic can be achieved at the surgical site without systemic side effects [8,9,15,17] (Table 1). However, cannulation of a foot vein is difficult, time-consuming, and may compromise sterility.…”

“…Coagulase-negative staphylococci (CoNS), one of the most common causes of infection post-TKA, have relatively high MICs against cephalosporins [28]. Conventional systemic dosing of prophylactic cephalosporins may therefore lead to inadequate tissue concentrations against these organisms [8,28].…”

Regional Prophylaxis with Teicoplanin in Monolateral or Bilateral Total Knee Replacement: an Open Study

“…Furthermore, the levels of teicoplanin in serum, which during surgery are very low and sometimes undetectable, rise within a few minutes after the tourniquet is released at the end of the surgical procedures (6). The high concentrations of teicoplanin in the serum appear to be sufficient to prevent infection from an occasional bacteremia during the immediate postoperative period.…”

“…In monolateral and bilateral TKR procedures, we found in a previous study (6) that the injection of 400 mg of teicoplanin into a foot vein of the leg to be operated on after complete occlusion of the systemic circulation (regional prophylaxis) seems to be a safe and valuable prophylactic procedure. Indeed, it provides concentrations in tissues (skin, subcutaneous tissue, bone, and synovia) in the operative field which are 2 to 10 times higher than those achievable by injecting 800 mg of the same antibi-otic into an arm vein before application of the tourniquet (systemic prophylaxis).…”