Pharmacological evaluation of prophylactic anti-microbial use in laparoscopic cholecystectomy; an open labelled study evaluating theconcentrations of single dose intravenous ceftriaxone at serum and tissue level.

Abstract

The goal of administering preoperative systemic prophylactic antibiotics is to have the concentration in the tissues at its optimum level at the start and throughout the surgery. The rationale for the use of antibiotics is not well accepted; possible side effects and development of microbial resistance patterns are potential risks along with the financial burden. Therefore, the present study was conducted with the aim to clinically evaluate the serum and tissue concentration of single-dose prophylactic ceftriaxone during an ongoing laparoscopic cholecystectomy (LC) and to find out risk factors for post operative surgical site infections (SSI). It was an open labelled prospective study in 50 consecutive patients who underwent elective laparoscopic cholecystectomy under prophylactic cover of ceftriaxone. Serum and tissue concentration were estimated by HighPerformanceLiquidChromatography during the ongoing surgery. Subjects were observed for any post-operative complications including SSI. Serum and tissue concentrations of ceftriaxone were significant at test value of 4milligrams/Litre. Body mass index was significantly correlated with the tissue concentration of ceftriaxone at the time of incision. The rate of SSI was 2%. It significantly correlated with age more than 60years, diabetes and infected bile. A single prophylactic intra-venous dose of 1g ceftriaxone immediately prior to skin incision in LC is good enough for prevention of SSI in Indian patients.