Comparative study of systemic intravenous and regional intravenous administration of prophylactic antibiotic in lower extremity orthopaedic surgery

Abstract

In this study, we describe a technique for the delivery of regional antibiotic prophylaxis in patients undergoing reconstructive surgery in the lower extremities and compare the tissue antibiotic concentrations achieved by this technique with those achieved by standard systemic intravenous prophylaxis. The efficacy of a regional route for antibiotic prophylaxis in lower extremity orthopaedic procedures was investigated in 20 patients and compared with the standard systemic intravenous method in 45 patients using a second generation cephalosporin (ceforanide). The antibiotic (2 g) was given intravenously as the standard systemic prophylaxis at different intervals (10, 20 min and 2 h) before tourniquet inflation. The same dose of antibiotic was injected intravenously into the ipsilateral foot after the inflation of tourniquet. Samples of bone, fat and muscle were collected during the operation and assayed for ceforanide by a microbiological method. None of the patients experienced local or systemic adverse following the regional administration of ceforanide, or infections during the postoperative and follow-up period. Peak tissue levels of the systemic antibiotic were observed when the antibiotic was given 20 min before tourniquet inflation. For all tissue samples, the antibiotic levels were significantly higher when the antibiotic was given regionally (P < 0.001). The results of this study suggest that the regional administration could be a useful route for prophylaxis during lower extremity orthopaedic procedures when they are carried out under tourniquet control.