Sequential Levels of Ceftriaxone in Intervertebral Disc Removed As Part of Scoliosis Surgery

Lang, Roberto M.; Folman, Yoram; Ravid, M; Bental, T; Gepstein, Reuven

doi:10.1097/00003086-199506000-00022

Cited by 6 publications

(7 citation statements)

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“…Variation in the rate of diffusion for different antibiotics may be due to multiple factors, including molecular size and charge, serum protein binding, and antibiotic solubility in different tissues. Rhoten et al [22] and Lang et al [24] suggested that higher doses of cephalosporins are required to achieve therapeutic levels in the disc. Hoelscher et al [25] have shown that high doses of antibiotics, including both cephalosporins and aminoglycosides, could have deleterious effects on the survival of cultured disc cells, cell proliferation and metabolic rates.…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Study for Antibiotic Prophylaxis in Spine Surgery: Choice of Drug, Dosage, and Timing

Nishant¹,

Kailash

Vijayraghavan

2013

Asian Spine J

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Study DesignProspective randomized study of antibiotic prophylaxis in elective spine surgery.PurposeThe aim of this study was to compare the rate of postoperative surgical site infection for a single dose of two different generations of cephalosporin with different dosage and timing of the antibiotics.Overview of LiteratureCurrent recommendation for prophylaxis in elective spine surgery is up to 60 minutes prior to incision. No study has investigated between different generation of cephalosporin for prophylaxis in elective spine surgery with respect to choice, dosage and timing.MethodsThis study was a prospective randomized study of 90 patients, assessed for the occurrence of surgical site infection (defined by the Centers for Disease Control and Prevention criteria) and other infections for up to 6 months after surgery. Demographic, surgical and further data were collected on subsequent operations, including hardware removal.ResultsMean age in our group was 47 years (range, 19-71 years). The male to female ratio was 49:41 and the average timing of administration of antibiotics was 77 minutes (range, 30-120 minutes). The average blood loss was 626 mL (range, 150-3,000 mL) with a mean duration of surgery for 3.2 hours (range, 1.5-6 hours). One case of superficial infection and one case of deep infection met the exclusion criteria.ConclusionsOur results support the use of a single preoperative dose of antibiotics in instrumented and non-instrumented elective spine surgery up to one hour prior to incision. There was no difference in terms of occurrence of surgical site infection with respect to dosage, choice and timing of antibiotics.

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Section: Discussionmentioning

confidence: 99%

Prospective Randomized Study for Antibiotic Prophylaxis in Spine Surgery: Choice of Drug, Dosage, and Timing

Nishant¹,

Kailash

Vijayraghavan

2013

Asian Spine J

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“…Prophylaxis against infection during spinal surgery has thus been advocated. 3,5,[7][8][9][10][11][12] There is still controversy, however, as to which antibiotics are capable of penetrating the disc in effective therapeutic concentrations. 7,10,[12][13][14][15][16] The efficacy of antibiotics depends upon both the anatomy and the permeability of the intervertebral disc.…”

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confidence: 99%

Antibiotic prophylaxis in surgery of the intervertebral disc: A comparison between gentamicin and cefuroxime

Tai¹,

Want²,

Quraishi³

et al. 2002

The Journal of Bone and Joint Surgery

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Antibiotics are often administrated prophylactically in spinal procedures to reduce the risk of infection of the disc space. It is still not known which antibiotics are able to penetrate the intervertebral disc effectively. In a prospective, randomised, double-blind clinical study, we examined the penetration of the intervertebral discs of two commonly used antibiotics, cefuroxime and gentamicin. The patients, randomised into two groups, received either 1.5 g of cefuroxime or 5 mg/kg of gentamicin prophylactically two hours before their intervertebral discs were removed. A specimen of blood, from which serum antibiotic levels were determined, was obtained at the time of discectomy. Therapeutic levels of antibiotic were detectable in the intervertebral discs of the ten patients who received gentamicin. Only two of the ten patients (20%) who received cefuroxime had a quantifiable level of antibiotic in their discs although therapeutic serum levels of cefuroxime were found in all ten patients. Our results show that cefuroxime does not diffuse into human intervertebral discs as readily as gentamicin. It is possible that the charge due to ionisable groups on the antibiotics can influence the penetration of the antibiotics. We therefore recommend the use of gentamicin in a single prophylactic dose for all spinal procedures in order to reduce the risk of discitis.

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“…Cephalosporins have a broad antibacterial spectrum, are resistant to beta-lactamase, and exhibit less allergic cross reactivity with penicillin. For its distribution through most body fluids and tissues (including joints, bone and soft tissues), clinical and experimental evidence supports prophylactic use of cephalosporin antibiotic against these organisms that are commonly isolated in discitis [19,20]. The specific microorganism of disc space infections was S. aureus, Bacillus coli, and Bacillus aeruginosus [1,2,4].…”

Section: Discussionmentioning

confidence: 99%

“…However, clinical and experimental evidence supports prophylactic use of cephalosporin antibiotic against these organisms that are commonly isolated in discitis, which distributed through most body fluids and tissues (including joints and bone tissues) [19,20]. Animal studies showed cephalosporin diffusion into the disc, and many factors influence the recovery of cephazolin from tissue samples [20,27]. The factors influence the recovery of cephazolin from tissue samples, including tissue protein binding [28], the selectivity of the solid-phase cartridge and the choice of medium for homogenization.…”

Section: Discussionmentioning

confidence: 99%

Determination of cephazolin, ceftazidime, and ceftriaxone distribution in nucleus pulposus

Yan

Zhang

et al. 2012

Arch Orthop Trauma Surg

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Sequential Levels of Ceftriaxone in Intervertebral Disc Removed As Part of Scoliosis Surgery

Cited by 6 publications

References 0 publications

Prospective Randomized Study for Antibiotic Prophylaxis in Spine Surgery: Choice of Drug, Dosage, and Timing

Prospective Randomized Study for Antibiotic Prophylaxis in Spine Surgery: Choice of Drug, Dosage, and Timing

Antibiotic prophylaxis in surgery of the intervertebral disc: A comparison between gentamicin and cefuroxime

Determination of cephazolin, ceftazidime, and ceftriaxone distribution in nucleus pulposus

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