PROSPECTIVE RANDOMIZED COMPARISON OF CEFODIZIME VERSUS CEFUROXIME FORPERIOPERATIVE PROPHYLAXIS IN PATIENTS UNDERGOING CORONARY-ARTERY BYPASS-GRAFTING

The effects of cefodizime and cefuroxime on neutrophil phagocytosis an d reactive oxygen production in 54 patients undergoing elective corona ry artery bypass grafting were studied, Both drugs were administered t wice at a dosage of 40 mg/kg of body weight (pre- and intraoperative), Phagocytic capacity was assessed by measuring the uptake of fluoresce in isothiocyanate-labeled Escherichia coli and Staphylococcus aureus b y flow cytometry, Reactive oxygen generation after phagocytosis was es timated by determining the amount of dihydrorhodamine 123 converted to rhodamine 123 intracellularly. In both groups the mean phagocytic abi lity for E. coli and S. aureus decreased during surgery (-21 and -8%, respectively, for the cefodizime group and -39 and -38%, respectively, for the cefuroxime group; P < 0.05 for all), In the cefodizime group a normalization of mean E. coli and S. aureus neutrophil phagocytosis was seen on day 5 (+9 and -4% compared to preoperative values; P > 0.3 5 for both), whereas in cefuroxime-treated patients phagocytic ability remained depressed (-37 and -31%; P < 0.04 for both), In both groups mean neutrophil reactive oxygen intermediate (ROI) production after E. coli and S. aureus phagocytosis increased during cardiopulmonary bypa ss (+44 and +83%, respectively, in the cefodizime group and +58 and +7 3%, respectively, in the cefuroxime group; P < 0.05 for all), One day after surgery E. coli- and S. aureus-driven neutrophil ROI production was not different from the preoperative values (-2 and +12%, respectiv ely, for the cefodizime group and +7 and +15%, respectively, for the c efuroxime group; P > 0.15 for all), Postoperative serum levels of the e-reactive protein on days 2 and 7 were lower in cefodizime-treated pa tients (19 +/- 6 and 4 +/- 2 mg/liter versus 23 +/- 6 and 11 +/- 5 mg/ liter; P < 0.05 for both), In addition to cefodizime's antimicrobial a ctivity during perioperative prophylaxis, its use in coronary artery b ypass grafting can prevent procedure-related prolonged postoperative n eutrophil phagocytosis impairment.