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Antibiotic Prophylaxis in Open-Heart Surgery: A Comparison of Cefamandole, Cefuroxime, and Cefazolin

1988; Elsevier BV; Volume: 46; Issue: 2 Linguagem: Inglês

10.1016/s0003-4975(10)65890-0

1552-6259

Layne O. Gentry, Barry Zeluff, Denton A. Cooley,

Antibiotics Pharmacokinetics and Efficacy

We undertook a prospective randomized evaluation of cefamandole nafate, cefuroxime sodium, and cefazolin sodium as prophylaxis in open-heart operations.A total of 903 patients having an elective procedure were enrolled in the study, and 620 of them were eventually considered evaluable.There were no significant differences between the three study groups.The overall rate of infection and the rate of infection according to demographic variables was not significantly different between the three antibiotics.Serious complications and deaths were also similar between the three agents.The presence of multiple severe underlying conditions was a risk factor for infection, independent of the antibiotic used.We conclude that there are no differences in the efficacies of the three agents in preventing postoperative infections in patients having open-heart operation.Cefuroxime, principally because of its every-12-hour dose, is far less expensive than cefamandole or cefazolin.Antibiotic prophylaxis in open-heart surgery was used for one of the first times in 1963 [l], in an effort to prevent an unacceptably high incidence of prosthetic heart valve endocarditis, later documented in 1965 [2].Initially, penicillin and streptomycin were used to combat gram-positive skin flora, especially Staphylococcus aureus and S. epidermidis, opportunistic to patients undergoing sternotomy.Between 1964 and 1977, much "folklore" was accumulated regarding the use of antibiotics in preventing infections.In particular, the benefit of prophylaxis for patients undergoing aorta-coronary artery bypass procedures was still unclear in 1978.In 1979, using rigid criteria for an evaluable study of prophylaxis [3], a prospective double-blind drug-versusplacebo trial proved that preoperative treatment with methicillin sodium prevented infections in patients undergoing aorta-coronary artery bypass procedures [4]; in fact, none of the methicillin-treated patients had a postoperative infection, while 21% of the patients who received the placebo did.There have been reports of low-risk open-heart operations "without" antibiotic prophylaxis [5].However, these procedures utilized continuous intrapericardial lavage with an antibiotic-laden irrigant.Although we prefer intravenous administration because of the improved dosage accuracy, continuous