a Department of Gastrointestinal Surgery , University Hospital of North Norway , Tromsø , Norway.
b Department of Laboratory Medicine , University Hospital of North Norway , Tromsø , Norway.
Infect Dis (Lond). 2017 Nov-Dec;49(11-12):785-791. doi: 10.1080/23744235.2017.1342044. Epub 2017 Jun 28.
Antibiotic prophylaxis is recommended prior to a wide range of gastrointestinal operations to reduce the rate of surgical site infections (SSIs). Traditional intravenous (IV) drugs are costly and their preparation strains nursing resources at the wards. While oral administration may attenuate these limitations, its use remains limited. We aimed to assess whether a dual oral antibiotic prophylaxis regimen provides adequate serum concentrations throughout the surgical procedure.
We measured serum concentrations of doxycycline and metronidazole following single oral doses of 400 mg doxycycline and 1200 mg metronidazole at first incision and repeated at wound closure in a cohort of patients undergoing elective gastrointestinal surgery. Both drugs were dispensed at least two hours before skin incision. Serum concentrations were compared to minimum inhibitory concentrations (MIC) and epidemiological cut-off values (ECOFFs) for relevant pathogens.
Mean serum concentrations of doxycycline at first incision and at wound closure were 5.75 mg/L and 4.66 mg/L and of metronidazole 18.88 mg/L and 15.56 mg/L, respectively. Metronidazole concentrations were above ECOFF (2 mg/L) for relevant anaerobic species in 103/104 of patients in both samples. Doxycycline serum concentrations were above the ECOFF for common Enterobacteriaceae species (4 mg/L) in both samples in 58/104 patients (55.8%).
A single dose of orally administered metronidazole provides adequate concentrations throughout surgery in a heterogeneous cohort of patients. Uncertainty persists regarding the adequacy of doxycycline concentrations, as the optimal serum level of doxycycline in a prophylactic setting has not been established.
在广泛的胃肠道手术之前，建议使用抗生素预防措施来降低手术部位感染（SSI）的发生率。传统的静脉（IV）药物成本高，且其配制会给病房的护理资源带来压力。虽然口服给药可能会减轻这些限制，但它的使用仍然受到限制。我们旨在评估双重口服抗生素预防方案是否能在整个手术过程中提供足够的血清浓度。
我们在接受择期胃肠道手术的患者队列中，在首次切口时给予 400mg 强力霉素和 1200mg 甲硝唑单次口服剂量，并在伤口闭合时重复给予，测量强力霉素和甲硝唑的血清浓度。两种药物均在皮肤切开前至少两小时给予。将血清浓度与相关病原体的最低抑菌浓度（MIC）和流行病学切割值（ECOFF）进行比较。
首次切口和伤口闭合时强力霉素的平均血清浓度分别为 5.75mg/L 和 4.66mg/L，甲硝唑的平均血清浓度分别为 18.88mg/L 和 15.56mg/L。在两个样本中，103/104 例患者的甲硝唑浓度均高于相关厌氧菌的 ECOFF（2mg/L）。在两个样本中，58/104 例患者的强力霉素血清浓度均高于常见肠杆菌科细菌的 ECOFF（4mg/L）。
在异质患者队列中，单次口服甲硝唑给药可在整个手术过程中提供足够的浓度。关于强力霉素浓度的充分性仍存在不确定性，因为预防性应用中强力霉素的最佳血清水平尚未确定。
