cefamandole and Pericardial-Effusion

Doses of 30 mg of ceforanide or cefamandole per kg were administered intravenously to 26 patients just before their chests were opened for coronary artery bypass or cardiac valve replacement surgery. Samples of right atrial appendage, pericardial fluid, plasma, aortic wall, intercostal muscle, and sternum were obtained at different times after the antibiotic was injected, and these samples were assayed for cephalosporin concentration. For ceforanide the pre-bypass plasma half-life was 2.5 h, and the atrial appendage half-life was 2.1 h; for cefamandole the pre-bypass plasma half-life was 0.75 h and the atrial appendage half-life was 0.72 h. At 3 h the concentrations of ceforanide and cefamandole in atrial appendages were 28.0 and 5.0 micrograms/g, respectively. Ceforanide achieved higher and more sustained concentrations in other tissues than cefamandole. Considering the minimal inhibitory concentrations of these drugs for staphylococci, cefamandole and ceforanide should provide adequate protection against infection by these organisms for the duration of the surgical procedure.

Topics: Cardiac Surgical Procedures; Cefamandole; Cephalosporins; Half-Life; Humans; Muscles; Myocardium; Pericardial Effusion; Pericardium; Premedication; Ribs; Staphylococcal Infections; Sternum

In 24 patients undergoing open-heart operation, 2 gm of cefamandole was administered intravenously by bolus technique at various time intervals prior to operation. Samples of pericardial fluid, atrial appendage tissue, and serum were obtained simultaneously in order to compare antibiotic levels in these sites as a function of time. All samples were microbiologically assayed by disc diffusion. Using linear regression analysis, the atrial appendage and serum half-lives for cefamandole were 36 and 38 minutes, respectively. At 40 minutes, peak levels of cefamandole were observed both in pericardial fluid and in atrial appendage tissue. The peak concentrations of cefamandole were 50 micrograms/gm in atrial appendage and 25 micrograms/ml for free drug content in pericardial fluid. These amounts were appreciably above the mean minimum inhibitory concentration of cefamandole for penicillin-resistant staphylococci, the usual pathogens grown in infections following implant operation.

Topics: Aged; Cefamandole; Cephalosporins; Coronary Artery Bypass; Half-Life; Heart Atria; Heart Valve Prosthesis; Humans; Microbial Sensitivity Tests; Middle Aged; Pericardial Effusion; Staphylococcal Infections; Surgical Wound Infection