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. 1978 Jun;13(6):924–929. doi: 10.1128/aac.13.6.924

Comparison of Cephalothin and Cefamandole Prophylaxis During Insertion of Prosthetic Heart Valves

Gordon L Archer 1, Ron E Polk 1, Richard J Duma 1, Richard Lower 2
PMCID: PMC352364  PMID: 354521

Abstract

Cefamandole nafate (CM) and cephalothin sodium (CP) were administered as prophylaxis in a randomized, prospective study to 30 consecutive patients undergoing prosthetic cardiac valve insertion. A single dose of 20 mg/kg was given intramuscularly during anesthesia induction, and serial plasma antibiotic concentrations, atrial muscle and cardiac valve tissue antibiotic levels, plasma bactericidal activity against pathogenic staphylococci, and infectious complications were determined and compared for the two drugs. Both antibiotics produced high plasma levels (>20 μg/ml 30 min after injection) which fell less than 25% during the period of cardiopulmonary bypass. However, CM levels were significantly higher at most time periods (P<0.05) than CP levels. CP levels were undetectable in atrial muscle from 14 of 15 patients and in valves from 10 of 15 patients. In contrast, CM bioactivity was found in all tissues. Differences in tissue antibiotic concentration could not be accounted for by differences in plasma concentrations or by CP tissue binding and were assumed to be caused by differences in penetration. Plasma bactericidal activity against staphylococci was equal for the two drugs (median titer, 1:16). No infections were seen in either group. CM appeared to be an effective and perhaps preferable prophylactic antibiotic for use during cardiac surgery.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barza M., Miao P. V. Antimicrobial spectrum, pharmacology and therapeutic use of antibiotics. Part 3: cephalosporins. Am J Hosp Pharm. 1977 Jun;34(6):621–629. [PubMed] [Google Scholar]
  2. Bergeron M. G., Nguyen B. M., Trottier S., Gauvreau L. Penetration of cefamandole, cephalothin, and desacetylcephalothin into fibrin clots. Antimicrob Agents Chemother. 1977 Dec;12(6):682–687. doi: 10.1128/aac.12.6.682. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Conte J. E., Jr, Cohen S. N., Roe B. B., Elashoff R. M. Antibiotic prophylaxis and cardiac surgery. A prospective double-blind comparison of single-dose versus multiple-dose regimens. Ann Intern Med. 1972 Jun;76(6):943–949. doi: 10.7326/0003-4819-76-6-943. [DOI] [PubMed] [Google Scholar]
  4. Dismukes W. E., Karchmer A. W., Buckley M. J., Austen W. G., Swartz M. N. Prosthetic valve endocarditis. Analysis of 38 cases. Circulation. 1973 Aug;48(2):365–377. doi: 10.1161/01.cir.48.2.365. [DOI] [PubMed] [Google Scholar]
  5. Fong I. W., Ralph E. D., Engelking E. R., Kirby W. M. Clinical pharmacology of cefamandole as compared with cephalothin. Antimicrob Agents Chemother. 1976 Jan;9(1):65–69. doi: 10.1128/aac.9.1.65. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Goldmann D. A., Hopkins C. C., Karchmer A. W., Abel R. M., McEnany M. T., Akins C., Buckley M. J., Moellering R. C., Jr Cephalothin prophylaxis in cardiac valve surgery. A prospective, double-blind comparison of two-day and six-day regimens. J Thorac Cardiovasc Surg. 1977 Mar;73(3):470–479. [PubMed] [Google Scholar]
  7. Goodman J. S., Schaffner W., Collins H. A., Battersby E. J., Koenig M. G. Infection after cardiovascular surgery. Clinical study including examination of antimicrobial prophylaxis. N Engl J Med. 1968 Jan 18;278(3):117–123. doi: 10.1056/NEJM196801182780301. [DOI] [PubMed] [Google Scholar]
  8. Harwick H. J., Weiss P., Fekety F. R., Jr Application of microtitration techniques to bacteriostatic and bactericidal antibiotic susceptibility testing. J Lab Clin Med. 1968 Sep;72(3):511–516. [PubMed] [Google Scholar]
  9. Hoeffler U., Ko H. L., Pulverer G. Antimicrobiol susceptibility of Propinibacterium acnes and related microbial species. Antimicrob Agents Chemother. 1976 Sep;10(3):387–394. doi: 10.1128/aac.10.3.387. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Keys T. F., Hewitt W. L. Endocarditis due to Micrococci and Staphylococcus epidermidis. Arch Intern Med. 1973 Aug;132(2):216–220. [PubMed] [Google Scholar]
  11. Kluge R. M., Calia F. M., McLaughlin J. S., Hornick R. B. Serum antibiotic concentrations pre- and postcardiopulmonary bypass. Antimicrob Agents Chemother. 1973 Sep;4(3):270–276. doi: 10.1128/aac.4.3.270. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Kluge R. M., Calia F. M., McLaughlin J. S., Hornick R. B. Sources of contamination in open heart surgery. JAMA. 1974 Dec 4;230(10):1415–1418. [PubMed] [Google Scholar]
  13. Kornguth M. L., Kunin C. M. Distribution of gentamicin and amikacin in rabbit tissues. Antimicrob Agents Chemother. 1977 Jun;11(6):974–977. doi: 10.1128/aac.11.6.974. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Myerowitz P. D., Caswell K., Lindsay W. G., Nicoloff D. M. Antibiotic prophylaxis for open-heart surgery. J Thorac Cardiovasc Surg. 1977 Apr;73(4):625–629. [PubMed] [Google Scholar]
  15. Neu H. C. Cefamandole, a cephalosporin antibiotic with an unusually wide spectrum of activity. Antimicrob Agents Chemother. 1974 Aug;6(2):177–182. doi: 10.1128/aac.6.2.177. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Polk R. E., Archer G. L., Lower R. Cefamandole kinetics during cardiopulmonary bypass. Clin Pharmacol Ther. 1978 Apr;23(4):473–480. doi: 10.1002/cpt1978234473. [DOI] [PubMed] [Google Scholar]
  17. Sabath L. D., Garner C., Wilcox C., Finland M. Susceptibility of Staphylococcus aureus and Staphylococcus epidermidis to 65 antibiotics. Antimicrob Agents Chemother. 1976 Jun;9(6):962–969. doi: 10.1128/aac.9.6.962. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Slaughter L., Morris J. E., Starr A. Prosthetic valvular endocarditis. A 12-year review. Circulation. 1973 Jun;47(6):1319–1326. doi: 10.1161/01.cir.47.6.1319. [DOI] [PubMed] [Google Scholar]
  19. Washington J. A. The in vitro spectrum of the cephalosporins. Mayo Clin Proc. 1976 Apr;51(4):237–250. [PubMed] [Google Scholar]
  20. Williams D. J., Steele T. W. Cephalothin prophylaxis assay during cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1976 Feb;71(2):207–211. [PubMed] [Google Scholar]
  21. Wold J. S. Rapid analysis of cefazolin in serum by high-pressure liquid chromatography. Antimicrob Agents Chemother. 1977 Jan;11(1):105–109. doi: 10.1128/aac.11.1.105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Zygmunt W. A., Browder H. P., Tavormina P. A. Susceptibility of coagulase-negative staphylococci to lysostaphin and other antibiotics. Appl Microbiol. 1968 Aug;16(8):1168–1173. doi: 10.1128/am.16.8.1168-1173.1968. [DOI] [PMC free article] [PubMed] [Google Scholar]

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