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Related Experiment Videos

Dicloxacillin concentrations in amputation.

L N Jørgensen1, J J Andreasen, P T Nielsen

  • 1Department of Orthopedics, Central Hospital, Hillerød, Denmark.

Acta Orthopaedica Scandinavica
|October 1, 1989
PubMed
Summary
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Administering dicloxacillin immediately before lower limb amputation surgery maximizes tissue antibiotic levels. This optimal timing helps ensure concentrations exceed the minimum inhibitory concentration (MIC) for Staphylococcus aureus, crucial for surgical site infection prevention.

Area of Science:

  • Pharmacology
  • Surgical Infection Prophylaxis
  • Orthopedic Surgery

Background:

  • Surgical site infections (SSIs) are a risk in major lower limb amputations.
  • Ischemia-related amputations may have altered tissue perfusion, affecting antibiotic distribution.
  • Optimizing antibiotic timing is critical for effective perioperative prophylaxis.

Purpose of the Study:

  • To determine the optimal timing for intravenous dicloxacillin administration before lower limb amputation surgery.
  • To evaluate the impact of dicloxacillin timing on tissue and drain fluid concentrations relative to Staphylococcus aureus MIC.
  • To assess the duration of effective antibiotic concentrations in surgical sites.

Main Methods:

  • 18 patients undergoing lower limb amputation due to ischemia were enrolled.

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  • Intravenous dicloxacillin (1g) was administered at 0, 3, or 6 hours pre-surgery.
  • A second dose was given 8 hours after the first.
  • Tissue (muscle, subcutaneous) and drain fluid dicloxacillin concentrations were measured.
  • Concentrations were compared against the minimum inhibitory concentration (MIC) for Staphylococcus aureus.

    • Main Results:

    • Immediate pre-operative dicloxacillin administration yielded the highest perioperative antibiotic concentrations in muscle and subcutaneous tissues.
    • These peak concentrations exceeded the MIC for Staphylococcus aureus.
    • Drain fluid concentrations were also highest with immediate pre-operative dosing.
    • Post-operative drain fluid concentrations fell below the MIC for Staphylococcus aureus by 12 hours.

    Conclusions:

    • Administering dicloxacillin immediately before major lower limb amputation surgery optimizes perioperative tissue concentrations.
    • This timing strategy ensures antibiotic levels surpass the MIC of Staphylococcus aureus at the surgical site.
    • Antibiotic prophylaxis effectiveness may be limited beyond 12 hours post-surgery, necessitating careful consideration of post-operative dosing strategies.