Weight‐based cefuroxime dosing provides comparable orthopedic target tissue concentrations between weight groups ‐ A microdialysis porcine study

Antibiotic prophylaxis is a key element in prevention of surgical site infections. For the majority of orthopedic procedures, antibiotic administration follows fixed dosing regimens irrespective of weight. However, this may result in insufficient antibiotic target tissue concentrations and higher risk of surgical site infections in obese individuals.

Aim

To investigate the effect of weight-based cefuroxime dosing on plasma and target tissue concentrations.

Eighteen female pigs were allocated into three groups differentiated by weight: 53-57kg, 73-77kg, and 93-97kg. Microdialysis catheters were placed for continuous sampling in bone, muscle and subcutaneous tissue during an 8-hour sampling interval. Blood samples were collected as reference. Cefuroxime was administered intravenously as a bolus according to weight (20 mg/kg). The primary endpoint was time above the cefuroxime minimal inhibitory concentration for Staphylococcus aureus (T>MIC (4 μg/mL)).

Comparable target tissue T>MICs (4 μg/mL) were found between weight groups. Mean T>MIC ranged between 116-137 min for plasma, 118-154 min for bone, 109-146 min for skeletal muscle, and 117-165 min for subcutaneous tissue across the groups.

Weight-based cefuroxime (20 mg/kg) dosing approach provide comparable perioperative plasma and target tissue T>MIC (4 μg/mL) in animals between 50 – 100 kg body weight, and thus a comparable prophylaxis of surgical site infections.

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