Ciprofloxacin levels in pleural fluid and serum during systemic administration after pneumonectomy

: Postpneumonectomy empyema represents a frequently lethal complication. It remains unsolved whether prophylactic antibiotics achieve a bactericidal concentration in the pleural cavity after pneumonectomy. 12 patients undergoing pneumonectomy received ciprofloxacin intravenously (2 x 200 micrograms/d) and orally (2 x 500 micromilligrams/d) during the first and second postoperative week, respectively. 1, 6, 9 and 14 days after the operation the ciprofloxacin concentration was measured in the pleural fluid and serum. Already after 24 hours bactericidal levels (0.56 microgram/ml) were found in the pleural fluid, rising to 1.11 micrograms/ml on day 14 under the higher oral dosage. Thus, it could be demonstrated that during the first two weeks after pneumonectomy high concentrations of an antibiotic similar to the levels in the serum can be achieved in the pleural fluid.