cefoxitin and Weight-Loss

Although >10% of surgical patients receive alternative antibiotic prophylaxis for reported penicillin allergies, it is estimated that <20% of such cases represent true allergies that preclude standard prophylaxis. Each antibiotic class has a distinct impact on the intestinal microbiota and on postoperative metabolomics. The community structure and function of the microbiota are linked to the ability to lose weight after bariatric surgery. This study demonstrates differential weight loss after laparoscopic sleeve gastrectomy between patients who received standard (cefoxitin) and alternative (levofloxacin and metronidazole) perioperative prophylaxis. Multivariate analysis demonstrates that alternative prophylaxis is significantly and independently associated with diminished postoperative weight loss.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bariatric Surgery; Cefoxitin; Female; Gastrectomy; Humans; Laparoscopy; Levofloxacin; Male; Metronidazole; Middle Aged; Obesity, Morbid; Postoperative Period; Retrospective Studies; Treatment Outcome; Weight Loss

Continuous and twice-daily cefoxitin dosing was used in a highly lethal model of acute peritonitis in mice using intraperitoneal (IP) Klebsiella pneumoniae (Kpn). The purpose was to use antibiotics to create a model of chronic infection. Male Balb/c mice (averaging 20 g body weight) were inoculated IP with 10(3) colony-forming units (CFU) Kpn serotype 2. Controls received subcutaneous saline either twice daily or continuously. Antibiotic groups received 300 mg/kg per day of cefoxitin either twice daily or continuously. Survival and daily weight losses were determined. Another group was inoculated with 10(3) Kpn given twice daily saline or cefoxitin and harvested at 24 hours. Leukocyte counts were performed on peritoneal exudate cells (PEC) and peripheral blood. Cultures determined Kpn counts in blood, lung, and PEC. By 24 hours, saline-treated animals had lost more weight than cefoxitin mice (1 g vs. 2 g, P < 0.05). Continuous cefoxitin showed significant advantage with 50 per cent mortality at 5 days. Kpn levels were not significantly altered by cefoxitin. Cefoxitin treatment extended chronicity by preventing weight loss and increasing survival in a highly lethal, monomicrobial peritonitis model. This model will allow future study of specific host defense mechanisms over a prolonged time period.

Topics: Animals; Anti-Bacterial Agents; Ascitic Fluid; Bacteremia; Cefoxitin; Chronic Disease; Colony Count, Microbial; Disease Models, Animal; Injections, Subcutaneous; Klebsiella Infections; Klebsiella pneumoniae; Leukocyte Count; Lung; Male; Mice; Mice, Inbred BALB C; Neutrophils; Peritonitis; Random Allocation; Serotyping; Survival Rate; Weight Loss