title: Optimal Cefazolin Prophylactic Dosing for Bariatric Surgery: No Need for Higher Doses or Intraoperative Redosing.
abstract: The goal of this pharmacokinetic (PK) study was to evaluate whether a single 2-g prophylactic dose of cefazolin given (IV) bolus provides effective protective cefazolin levels for prophylaxis against methicillin-sensitive S. aureus (MSSA), the primary skin pathogen in bariatric surgery.
  
  
  
  Thirty-seven patients having gastric bypass or sleeve gastrectomy received cefazolin 2-g preoperative prophylaxis. Serum, subcutaneous adipose tissue, and deep peri-gastric adipose tissue specimens were collected at incision and before skin closure. Cefazolin concentrations in serum and adipose tissue were determined by high-performance liquid chromatography.
  
  
  
  Penetration of cefazolin, a water soluble antibiotic, into adipose tissue was only 6-8 % of simultaneous serum levels. However, cefazolin tissue concentrations in all adipose tissue specimens, exceeded mean MIC for MSSA.
  
  
  
  Prophylactic cefazolin, given as a single 2 g (IV bolus 3-5 min before skin incision) was more than adequate in providing protective cefazolin levels for the duration of bariatric surgery. Cefazolin 2 g (IV dose bolus given just before skin incision) achieves protective adipose tissue levels (> MIC of MSSA) for the duration (usually < 4 h) of bariatric surgical procedures. In this study, cefazolin 2 g (IV bolus) provided protective adipose tissue levels for 4.8 h. Since cefazolin is a water soluble antibiotic (Vd= 0.2 L/Kg), penetration into adipose tissue is not Vdnot dose-dependent. Extremely high-dosed cefazolin, i.e., 3 or 4 g is excessive and unnecessary for bariatric surgery prophylaxis. A single cefazolin 2 g preoperative dose also eliminates the need for intraoperative redosing at 4 h.
authors: Department Pharmacy, Winthrop-University Hospital, Mineola, NY, USA.
authors: Xing
authors: X
authors: Chen
authors: Department of Surgery, Winthrop-University Hospital, Mineola, NY, USA.|State University of New York, School of Medicine, Stony Brook, NY, USA.|Center of Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA.
authors: Collin E M
authors: CE
authors: Brathwaite
authors: Department of Surgery, Winthrop-University Hospital, Mineola, NY, USA.
authors: Alexander
authors: A
authors: Barkan
authors: Department of Surgery, Winthrop-University Hospital, Mineola, NY, USA.
authors: Keneth
authors: K
authors: Hall
authors: Department of Surgery, Winthrop-University Hospital, Mineola, NY, USA.
authors: Gloria
authors: G
authors: Chu
authors: Department of Surgery, Winthrop-University Hospital, Mineola, NY, USA.
authors: Patricia
authors: P
authors: Cherasard
authors: Department Pharmacy, Winthrop-University Hospital, Mineola, NY, USA.
authors: Shan
authors: S
authors: Wang
authors: State University of New York, School of Medicine, Stony Brook, NY, USA.|Center of Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA.
authors: David P
authors: DP
authors: Nicolau
authors: Department of Biostatistics, Winthrop-University Hospital, Mineola, NY, USA.
authors: Shahidul
authors: S
authors: Islam
authors: State University of New York, School of Medicine, Stony Brook, NY, USA. bacunha@winthrop.org.|Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, 11501, USA. bacunha@winthrop.org.
authors: Burke A
authors: BA
authors: Cunha
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000592:standards*; D050110:Bariatric Surgery / Q000009:adverse effects; D002138:Calibration; D002437:Cefazolin / Q000008:administration & dosage* / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D054796:Drug Dosage Calculations; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery*; D013203:Staphylococcal Infections / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects; D013530:Surgical Wound Infection / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D002437:Cefazolin
keywords: Antibiotic intraoperative redosing; Cefazolin pharmacokinetics; Surgical antibiotic prophylaxis