Cefuroxime and metronidazole in gynaecological surgery

The predominant potential pathogens in the vaginal flora, sampled before operation in 41 patients undergoing gynaecological surgery, included E. coli, alpha-haemolytic streptococci, Streptococcus faecalis, anaerobic Gram-positive cocci and Bacteroides fragilis. All the aerobic Gram-negative bacilli and 89.7 per cent of the streptococci isolated were sensitive to 4 microgram/ml of cefuroxime. Most of the anaerobes were also very sensitive to cefuroxime, although the minimum inhibitory concentration (MIC) for 52 per cent of B, fragilis isolates was at least 8 microgram/ml. The MIC of metronidazole was less than 1 microgram/ml for almost all anaerobes. All patients were given 1 g of metronidazole by suppository on the night before operation and a second suppository was given, together with 750 mg of cefuroxime injected intramuscularly with the premedication. The mean extravascular tissue concentrations of cefuroxime and metronidazole, assayed in 29 patients, were respectively 8.9 and 8.0 microgram/g (uterus), 14.2 and 22.3 microgram/g (cervix), 13.1 and 6.3 microgram/g (Fallopian tube), 12.3 and 2.1 microgram/g (ovary), 10.3 and 12.4 microgram/g (vagina), 13.3 and 13.7 microgram/ml (serum), 3570.3 and 122.3 microgram/ml (urine). None of the patients developed postoperative wound infections or adverse reactions.