Optimal Cefazolin Prophylactic Dosing for Bariatric Surgery: No Need for Higher Doses or Intraoperative Redosing

• Published in: Obesity surgery Vol. 27; no. 3; pp. 626 - 629
• Main Authors: Chen, Xing, Brathwaite, Collin E. M., Barkan, Alexander, Hall, Keneth, Chu, Gloria, Cherasard, Patricia, Wang, Shan, Nicolau, David P., Islam, Shahidul, Cunha, Burke A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.03.2017; Springer Nature B.V
• Subjects: Adult; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - pharmacokinetics; Antibiotic Prophylaxis - methods; Antibiotic Prophylaxis - standards; Antibiotics; Bacterial infections; Bariatric Surgery - adverse effects; Calibration; Cefazolin - administration & dosage; Cefazolin - pharmacokinetics; Dose-Response Relationship, Drug; Drug Dosage Calculations; Drug therapy; Female; Gastrointestinal surgery; Humans; Intraoperative Care - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Obesity, Morbid - drug therapy; Obesity, Morbid - metabolism; Obesity, Morbid - surgery; Original Contributions; Preventive medicine; Staphylococcal Infections - prevention & control; Staphylococcus aureus - drug effects; Surgery; Surgical Wound Infection - prevention & control; Surgical antibiotic prophylaxis; Antibiotic intraoperative redosing; Cefazolin pharmacokinetics
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-016-2331-9

Purpose The goal of this pharmacokinetic (PK) study was to evaluate whether a single 2-g prophylactic dose of cefazolin given (IV) bolus provides effective protective cefazolin levels for prophylaxis against methicillin-sensitive S. aureus (MSSA), the primary skin pathogen in bariatric surgery. Materials and Methods Thirty-seven patients having gastric bypass or sleeve gastrectomy received cefazolin 2-g preoperative prophylaxis. Serum, subcutaneous adipose tissue, and deep peri-gastric adipose tissue specimens were collected at incision and before skin closure. Cefazolin concentrations in serum and adipose tissue were determined by high-performance liquid chromatography. Results Penetration of cefazolin, a water soluble antibiotic, into adipose tissue was only 6–8 % of simultaneous serum levels. However, cefazolin tissue concentrations in all adipose tissue specimens, exceeded mean MIC for MSSA. Conclusions Prophylactic cefazolin, given as a single 2 g (IV bolus 3–5 min before skin incision) was more than adequate in providing protective cefazolin levels for the duration of bariatric surgery. Cefazolin 2 g (IV dose bolus given just before skin incision) achieves protective adipose tissue levels (> MIC of MSSA) for the duration (usually < 4 h) of bariatric surgical procedures. In this study, cefazolin 2 g (IV bolus) provided protective adipose tissue levels for 4.8 h. Since cefazolin is a water soluble antibiotic ( V d  = 0.2 L/Kg), penetration into adipose tissue is not V d not dose-dependent. Extremely high-dosed cefazolin, i.e., 3 or 4 g is excessive and unnecessary for bariatric surgery prophylaxis. A single cefazolin 2 g preoperative dose also eliminates the need for intraoperative redosing at 4 h.