amoxicillin-potassium-clavulanate-combination and Arterial-Occlusive-Diseases

The combinations of cefuroxime and metronidazole, and amoxycillin/clavulanate (Augmentin) are useful as prophylactic drugs during vascular surgery. In this study the pharmacokinetic profiles of different dosing regimens utilizing these drugs during reconstructive vascular procedures are presented. Three groups of patients, undergoing aortobifemoral or femoropopliteal prosthetic surgery, received one of the following regimens: Group I: 1500 mg metronidazole plus 1500 mg cefuroxime at premedication, Group II: 1500 mg metronidazole at premedication plus 1500 mg cefuroxime at the time of induction anaesthesia, followed by 750 mg of cefuroxime 2 h later, Group III: 2000 mg amoxycillin/200 mg clavulanate at time of induction anaesthesia, followed by 1000 mg amoxycillin/200 mg clavulanate, 3 h later. For determination of the antibiotic concentrations, arterial blood samples were obtained at 30-minute intervals during the entire procedure. An additional sample was collected at the time of inguinal graft site anastomosis. Cefuroxime concentrations in these additional samples were 29.3 +/- 11.2 mg/l in group I and 44.7 +/- 15.9 mg/l in group II. Metronidazole concentrations were satisfactorily high in all patients (38.4 +/- 4.5 mg/l). Amoxycillin/clavulanate concentrations were 35.1 +/- 21.5 mg/l and 4.4 +/- 3.7 mg/l respectively. We recommend a multiple dose administration scheme for prophylaxis in high-risk prosthetic vascular surgery, if the procedure takes more than 2-3 h and antimicrobial agents with a rapid elimination time are used. A multiple dosing scheme ensures sufficiently high antibiotic concentrations, exceeding the MIC of staphylococci and enterobacteria approximately twice, at the time of inguinal graft site anastomosis.

Topics: Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Aorta, Abdominal; Arterial Occlusive Diseases; Blood Vessel Prosthesis; Cefuroxime; Clavulanic Acids; Drug Therapy, Combination; Female; Femoral Artery; Humans; Infusions, Intravenous; Injections, Intravenous; Male; Metronidazole; Middle Aged; Popliteal Artery; Premedication; Surgical Wound Infection

We describe a case of acute ischemia of the 2nd, 3rd and 4th fingers of the right hand secondary to peripheral vascular occlusive disease induced by repeated intra-arterial cocaine injections. The complete occlusion of the distal arteries resolved following treatment with iloprost, a synthetic stable analogue of prostacyclin PGI2, in addition to anticoagulants and antibiotics.

Topics: Acute Disease; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anticoagulants; Arterial Occlusive Diseases; Cocaine-Related Disorders; Drug Therapy, Combination; Hand; Humans; Iloprost; Ischemia; Male; Nadroparin; Peripheral Vascular Diseases; Treatment Outcome; Vasodilator Agents