Netilmicin prophylaxis in open-heart surgery

Pericardial fluid, serum and atrial appendage concentrations of netilmicin and gentamicin were determined in 80 patients who received one or two pre-operative doses of either netilmicin 200 mg im or gentamicin 120 mg im. Mean atrial appendage concentrations of netilmicin and gentamicin after a single dose were 4.8 and 2.1 mg/kg; mean serum concentrations were 6.9 and 3.9 mg/l, and mean pericardial fluid concentrations 3.8 and 2.6 mg/l, respectively. After two doses apparent sequestration of the antibiotic in pericardial fluid was observed. A review of the cases of prosthetic valve endocarditis during the last decade suggests that aminoglycoside/isoxazolyl penicillin combinations provide good anti-staphylococcal prophylaxis. A change in the pattern of infections has been observed. The incidence of staphylococcal infection has fallen; early infections may be of fungal aetiology and late infections show a similar distribution of infecting organisms to that seen in native valve endocarditis.