Pharmacokinetic basis for oral perioperative prophylaxis with ofloxacin in general surgery.
BACKGROUND
Perioperative prophylaxis is recommended to be administered intravenously which, compared to oral prophylaxis, is more expensive. However, pharmacokinetic data on oral perioperative prophylaxis in patients with preoperative surgical and anesthesiological preparation are not available.


METHODS
40 patients with open hernial repair or cholecystectomy (low-risk group), colonic or pancreatic resection (high-risk group) received a standard single-dose perioperative prophylaxis with 4.5 g mezlocillin and 0.5 g metronidazole intravenously in addition to 400 mg ofloxacin orally 2 h prior to surgery. Antibiotic concentrations were measured perioperatively and pharmacokinetic data calculated.


RESULTS
Serum and tissue concentrations of ofloxacin were above the MIC90 of the potential bacterial spectrum for surgical infection throughout the entire operation. Pharmacokinetic data were not influenced by preoperative surgical or anesthesiological preparation.


CONCLUSIONS
Tissue and serum concentrations and the antibacterial spectrum of orally administered ofloxacin suggest effective protection against perioperative infection. Pharmacokinetic data confirm that oral ofloxacin may be used effectively as single-dose perioperative antibiotic prophylaxis. Since there are no clinical data comparing oral and intravenous singLe-dose prophylaxis, a prospective randomized clinical trial should be performed.
Schwarz
M
M
Dept. of General Surgery, University of Ulm, Germany.
Isenmann
R
R
Weikert
E
E
Ebeling
P
P
Thomsen
J
J
Beger
H G
HG
D000284:Administration, Oral; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D006801:Humans; D007275:Injections, Intravenous; D008795:Metronidazole / Q000493:pharmacokinetics / Q000627:therapeutic use; D008802:Mezlocillin / Q000493:pharmacokinetics / Q000627:therapeutic use; D015242:Ofloxacin / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D010406:Penicillins / Q000493:pharmacokinetics / Q000627:therapeutic use; D011300:Preoperative Care / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D010406:Penicillins; D008795:Metronidazole; D015242:Ofloxacin; D008802:Mezlocillin