Estudo da disposição cinética da cefuroxima em pacientes submetidos à cirurgia de revascularização do miocárdio com circulação extracorpórea e hipotermia / Cinetic disposition of cefuroxime in coronary artery bypass graft surgery with Cardiopulmonary bypass and hypothermia

AUTOR(ES)

Jorge Willian Leandro Nascimento

FONTE

IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia

DATA DE PUBLICAÇÃO

07/05/2004

RESUMO

Cardiopulmonary bypass and hypothermia (HCPB) is a procedure commonly used during heart surgery, representing a risk factor for the patient by promoting extensive hemodilution and profound physiological changes. Cefuroxime is used for the prophylaxis of infection after heart surgery and its minimum inhibitory concentration (MIC90) may vary from 4 to 16 µg/mL depending on the bacterial species and strain. Several dose schemes have been suggested for prophylaxis with this antimicrobial agent. Thus, the objective of the present study was to assess in a comparative manner the systemic availability of cefuroxime administered intravascularly at the dose of 1.5 g in bolus to 17 patients submitted to heart surgery with or without HCPB. An improved, simple, selective and sensitive micromethod based on HPLC-UV is described to determine cefuroxime in plasma and fat tissue. Despite the differences recorded during the study period as a consequence of HCPB, antibiotic concentrations lower than MIC90 were obtained as early as after the 9th h for the surgical patients of the two groups of patients investigated. Thus, the low systemic availability of cefuroxime after the administration of a 1.5 g dose may be the factor responsible for postoperative infections and may favor the development of resistant bacterial strains. By the other hand, cefuroxime kinetic disposition was altered by HCPB showing a slight prolongation of biological half-life e reduction of plasma clearance. Unchanged apparent volume of distribution was according antibiotic tissue penetration since in both groups of patients the amount of cefuroxime obtained was comparable. The data obtained permit us to recommend a change in the dose scheme in order to maintain adequate plasma levels of the drug and thus guarantee prophylaxis with cefuroxime.

ASSUNTO(S)

antibiotic penetration antibióticos (farmacocinética) antibiotics (pharmacocinetic) cec-h cefuroxima cefuroxime cinética de dissolução clae-uv clinical pharmacology farmacocinética farmacologia clínica fat tissue hcpb hplc-uv penetração do antibiótico pharmacokinetic plasma plasma tecido subcutâneo

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