[Cefotaxime levels in synovial fluid following intravenous administration]

The corresponding levels of cefotaxime in serum and synovial fluid were investigated in patients undergoing surgery under perioperative antibiotic medication. By investigating 32 samples a concentration band over 4 hours could be established. Clinically relevant levels of the drug could be found from 10 minutes after start of the intravenous dose with an increase up to 30 minutes. Between 30 and 90 minutes the average concentration was about 40 micrograms/ml. After 90 minutes a decrease of the concentration was found and the median lines for synovial and serum concentrations crossed at about 105 minutes. Even after 4 hours we found synovial titers of 10 to 20 micrograms/ml having therapeutical relevance. From the results we can conclude, that cefotaxime infusion of 2 g produced over hours therapeutical synovial levels being significantly over the break point of 16 micrograms/ml for bacteria susceptible to this antibiotic agent. On the other hand we strongly recommend not to wait too long with surgical intervention when a joint infection does not improve significantly in 48 hours under systemic antibiotic treatment.