Comparison of ceftriaxone and cefazolin prophylaxis against infection in open heart surgery

One hundred four patients undergoing elective open heart surgery were enrolled in a prospective, double-blind trial comparing prophylaxis against infection using a single 1 g dose of ceftriaxone and seven doses of cefazolin. Patients in both groups had similar risk factors for infection. The likelihood of achieving a tissue concentration in excess of the minimal inhibitory concentration for Staph. aureus was significantly greater with ceftriaxone in atrial appendage (p less than 0.001), muscle (p less than 0.01), and bone (p less than 0.01) than with cefazolin. The serum half-life of ceftriaxone was approximately 15.7 hours. All 49 serum samples obtained 18 to 24 hours after delivery of ceftriaxone and 26 of 33 samples obtained 40 to 48 hours after delivery had drug concentrations in excess of 3.1 micrograms/ml, the mean minimal inhibitory concentration for isolates of Staph. aureus. Early and late infectious complications were infrequent and occurred at similar rates in both groups. Neither drug was associated with significant toxicity. A single 1 g dose of ceftriaxone was as effective and safe as multiple doses of cefazolin and demonstrated superior tissue penetration.