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Journal of Bone and Joint Surgery - British Volume, Vol 84-B, Issue 7, 1036-1039.
doi: 10.1302/0301-620X.84B7.12862  
Copyright © 2002 by British Editorial Society of Bone and Joint Surgery
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Antibiotic prophylaxis in surgery of the intervertebral disc

A COMPARISON BETWEEN GENTAMICIN AND CEFUROXIME

C. C. Tai, MRCS, Specialist Registrar1; S. Want, PhD, Clinical Scientist2; N. A. Quraishi, MRCS, Specialist Registrar1; J. Batten, PhD, Research Assistant1; M. Kalra, MB BS, Clinical Assistant1; and S. P. F. Hughes, FRCS, Professor1

1 Department of Musculoskeletal Surgery, Faculty of Medicine, Imperial College of Science, Technology and Medicine, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
2 Department of Microbiology, Hammersmith Hospital, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, UK.

Correspondence should be sent to Mr C. C. Tai at the Department of Trauma and Orthopaedic Surgery, Barnet Hospital, Thames House, Well-house Lane, Barnet, Hertfordshire EN5 3DJ, UK.

Antibiotics are often administrated prophylactically in spinal procedures to reduce the risk of infection of the disc space. It is still not known which antibiotics are able to penetrate the intervertebral disc effectively. In a prospective, randomised, double-blind clinical study, we examined the penetration of the intervertebral discs of two commonly used antibiotics, cefuroxime and gentamicin. The patients, randomised into two groups, received either 1.5 g of cefuroxime or 5 mg/kg of gentamicin prophylactically two hours before their intervertebral discs were removed. A specimen of blood, from which serum antibiotic levels were determined, was obtained at the time of discectomy.

Therapeutic levels of antibiotic were detectable in the intervertebral discs of the ten patients who received gentamicin. Only two of the ten patients (20%) who received cefuroxime had a quantifiable level of antibiotic in their discs although therapeutic serum levels of cefuroxime were found in all ten patients. Our results show that cefuroxime does not diffuse into human intervertebral discs as readily as gentamicin. It is possible that the charge due to ionisable groups on the antibiotics can influence the penetration of the antibiotics. We therefore recommend the use of gentamicin in a single prophylactic dose for all spinal procedures in order to reduce the risk of discitis.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General