Cefuroxime versus ceftriaxone prophylaxis in cardiovascular surgery.

In a randomized, prospective study a 2-day course of cefuroxime prophylaxis (Zinacef, 1.5g every 12 h) was compared with 2-day ceftriaxone prophylaxis (Rocephin, 2g i.v. plus 1g i.v. after 24 h). To date 512 patients undergoing cardiac (n = 418) and major vascular surgery (n = 94) entered the study: 258 in the cefuroxime and 254 in the ceftriaxone group. The one-month lethality rate was 1.0%. The total infection rate was 4.7% (12 patients in the cefuroxime and 12 in the cefuroxime group. Septicaemia occurred in 1-4% (cefuroxime n = 4; ceftriaxone n = 3); pneumonia in 2% (5 vs 5 patients). One patient developed diarrhoea due to Clostridium difficile. Plasma concentrations of ceftriaxone were measured (HPLC method) over the first 24 h in 110 patients undergoing cardiac surgery. Plasma concentrations 24 h post-injection were 25.4 +/- 12.7 micrograms/ml. Prophylaxis with either cefuroxime or ceftriaxone was highly effective. The mean plasma levels of ceftriaxone achieved are far in excess of the MICs for the microorganisms commonly associated with infection following cardiovascular surgery, with the exception of Bacteroides and Pseudomonas. A single dose of ceftriaxone should therefore provide adequate prophylaxis for most patients undergoing major cardiovascular surgery.