Pharmacokinetic basis for oral perioperative prophylaxis with ofloxacin ingeneral surgery

Background: Perioperative prophylaxis is recommended to be administered int ravenously which, compared to oral prophylaxis, is more expensive. However, pharmacokinetic data on oral perioperative prophylaxis in patients with pr eoperative surgical and anesthesiological preparation are not available. Patients and Methods: 40 patients with open hernial repair or cholecystecto my (Low-risk group), colonic or pancreatic resection (high-risk group) rece ived a standard single-dose perioperative prophylaxis with 4.5 g mezlocilli n and 0.5 g metronidazole intravenously in addition to 400 mg ofloxacin ora lly 2 h prior to surgery. Antibiotic concentrations were measured periopera tively and pharmacokinetic data calculated. Results: Serum and tissue concentrations of ofloxacin were above the MIC90 of the potential bacterial spectrum for surgical infection throughout the e ntire operation. Pharmacokinetic data were not influenced by preoperative s urgical or anesthesiological preparation. Conclusion: Tissue and serum concentrations and the antibacterial spectrum of orally administered ofloxacin suggest effective protection against perio perative infection. Pharmacokinetic data confirm that oral ofloxacin may be used effectively as single-dose perioperative antibiotic prophylaxis. Sinc e there are no clinical data comparing oral and intravenous single-dose pro phylaxis, a prospective randomized clinical trial should be performed.