title: Perioperative cefuroxime pharmacokinetics in cardiac surgery.
abstract: OBJECTIVE
  The objective was to investigate the plasma levels and to compare the pharmacokinetics of cefuroxime during and after surgery in adult patients with elective indication for coronary artery bypass grafting.
  
  
  METHODS
  Seventeen patients received three 1.5-g bolus IV doses of cefuroxime, one every 12 hrs. Serial blood samples (3 mL) were collected 1, 3, 6, 9, and 12 hrs after the first dose (given during the intervention) and after the second and third doses (postsurgery). Blood samples were centrifuged and stored frozen until being assayed. For assessment of the cefuroxime plasma levels by liquid chromatography, only 200 microL of plasma were required. Determination of cefuroxime plasma levels was followed by a pharmacokinetic (PK)-modeling using PK Solutions 2.0 software.
  
  
  RESULTS
  The kinetic parameters obtained remained unchanged after the first, second, and the third dose as follows: elimination half-life: 1.8 h, 1.9 h, and 1.8 h; clearance: 1.4, 1.5, and 1.5 mL/min/kg, respectively. Additionally, the apparent volume of distribution did not change during and after the intervention: 0.19, 0.25, and 0.22 L/kg, after the first, second, and the third dose, respectively. Since the drug has a low volume of distribution, plasma levels obtained after a 1.5-g IV bolus injection of cefuroxime decreased rapidly due to the high plasma clearance, with a consequent short half-life.
  
  
  CONCLUSIONS
  The kinetic disposition of cefuroxime remains unaltered in patients undergoing coronary artery bypass grafting; to reduce the fluctuation in plasma concentrations so that the antibiotic prophylaxis in the peri-operative period is guaranteed, the dose regimen should be reviewed.
authors.affiliation: Pharmacy Department, School of Pharmaceutical Sciences, University Medical School Heart Institute, São Paulo, Brazil. willian@usp.br
authors.forename: Jorge Willian Leandro
authors.initials: JW
authors.lastname: Nascimento
authors.forename: Maria José Carvalho
authors.initials: MJ
authors.lastname: Carmona
authors.forename: Tânia Mara Varejão
authors.initials: TM
authors.lastname: Strabelli
authors.forename: José Otávio Costa
authors.initials: JO
authors.lastname: Auler
authors.forename: Sílvia Regina Cavani Jorge
authors.initials: SR
authors.lastname: Santos
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D019072:Antibiotic Prophylaxis; D002444:Cefuroxime / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D002851:Chromatography, High Pressure Liquid; D001026:Coronary Artery Bypass; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002444:Cefuroxime