Bone concentrations of cefuroxime and cefamandole in the femoral head in 96 patients undergoing total hip replacement surgery

Abstract

Ninety-six patients undergoing total hip replacement surgery received chemoprophylaxis with either cefuroxime (51 patients) or cefamandole (45 patients). The dosage with cefuroxime was either 750 mg given intramuscularly with the premedication (18 patients) or l·5 g given intravenously with induction of anaesthesia (33 patients). The remaining 45 patients received 1 g of cefamandole intravenously with anaesthetic induction. Bone concentrations depended on the time interval between the antibiotic injection and the removal of the femoral head. These ranged from 0·6 to 7·l mg/kg (mean 2 mg/kg) for the 750 mg dose of cefuroxime 85 to 150 mm after the dose. For the 1·5 g dose of cefuroxime the concentrations varied between 2·9 and 49·8 mg/kg (mean 19·4 mg/kg) 15 to 125 mm following the injection. With cefamandole the levels measured in cancellous bone ranged from 2·4–38·5 mg/kg (mean 12·6 mg/kg) 20 to 70 mm after the injection. The bone/serum concentration ratio was higher for cefamandole (0·36) than for cefuroxime (0·14 and 0·23). Cefuroxime and cefamandole achieve high concentrations in bone and are suitable as prophylactic agents in patients having total hip replacement.