Comparative pharmacokinetics of ceftriaxone after periincisional and intravenous administration in patients undergoing abdominal surgery.

Abstract The advantages of the preoperative periincisional infiltration (ppi) of ceftriaxone in the prophylaxis of surgical wound infections over the preoperative intravenous injection (piv) has been demonstrated by comparing the pharmacokinetics of the two routes of antibiotic administration and the clinical results. The study was conducted in 36 patients undergoing abdominal surgery. Eighteen of them received a 2 g ceftriaxone piv (group A) and the rest a similar dose by ppi (group B). The peak time, peak plasma concentration and the bioavailability for the ppi route were respectively 1.19±0.24 h, 96.9±3.8 μg/ml and 0.68±0.07. After piv, a typical bioexponential decline of plasma ceftriaxone levels from 256.7±37.5 μg/ml (0.5 h) to 15.7±7.5 μg/ml (24 h) was observed. Tissue and wound fluid antibiotic levels of patients from group B (range: for tissues 95–1850 μg/g, for fluid 62–1342 μg/ml) were much higher than for group A (range: for tissues 18–150 μg/g, for fluid 35–160 μg/ml). Adequate for chemoprophylaxis antibiotic plasma levels were measured in both patient groups 24 h post operatively (group A: 15.7±7.5 μg/ml, group B: 12.4±4.5 μg/ml). No wound infections or other complications were noted in group B. In contrast, three cases of wound infections and one case of pneumonia were observed in group A.