PENETRATION OF CEFOTAXIME INTO INTERVERTEBRAL DISCS REMOVED FROM PATIENTS UNDERGOING DISCECTOMY
Basrah Journal of Surgery,
2019, Volume 25, Issue 1, Pages 3-9
AbstractThe intervertebral disc is an avascular tissue, and penetration of antibiotics occurs by passive
diffusion. Cefotaxime penetration has not been well studied. The aim is to investigate the
penetration of cefotaxime into the intervertebral disc removed from patients undergoing
Twenty-six patients undergoing discectomy were recruited for this study. They were given one
gram of cefotaxime intravenously as a prophylactic antibiotic. Cefotaxime was extracted from
nucleus pulposus and serum and analyzed using an HPLC method with cefuroxime axetil as
Cefotaxime penetrated into all the 26 samples of nucleus pulposus resulting in a mean
concentration of 0.66±0.13 µg/gm. The mean serum concentration at time of disc removal was
13.61±3.54 µg/ml. The concentration in 16 samples were below the minimum inhibitory
concentration against Staph. aureus with an average of 0.27±0.03 µg/g. There is a statistically
significant correlation between time after intravenous cefotaxime administration and its
concentration in the nucleus pulposus. The greater increase is in the third hour after
administration. Factors like age, body weight, gender, number of associated diseases and
surgical history did not seem to affect nucleus pulposus cefotaxime concentration.
In conclusion, cefotaxime can penetrate into the nucleus pulposus but its concentration is
relatively low. This concentration has a strong positive correlation with time after cefotaxime
intravenous administration. Cefotaxime, therefore, needs to be given at least two hours before
disc removal, with re-dosing immediately before operation to maintain high serum concentration.
1.Osti OL, Vernon-Roberts B, Fraser RD (1990) Discitis after discography. The role of prophylactic
antibiotics. Spine 15:762–767. PMI:2312567
2. Motaghinasab S, Shirazi-Adl A, Urban JP, Parnianpour M (2012) Computational pharmacokinetics of solute
penetration into human intervertebral discs - effects of endplate permeability, solute molecular weight and disc
size. J Biotech 45:2195-2202. doi: 10.1016/j.jbiomech. 2012.06.033.
3. Lang R, Folman Y, Ravid M, Bental T, Gepstein R (1994) Penetration of ceftriaxone into the intervertebral
disc. J Bone Joint Surgery 76:689-691. PMID: 8175816
4. Walters R, Rahmat R, Fraser R, Moore R (2006) Preventing and treating discitis: cephazolin penetration in
ovine lumbar intervertebral disc. Eur Spine J 15: 1397-1403. PMID: 16830132
5. Lin CC, Wu YT, Yen JC, Chiang CJ, Tsuang YH, Tsai TH (2010) In vitro and in vivo methods to measure
the ceftriaxone distribution into the rat tail intervertebral disc. Anal Scio 26:979-982. PMID: 20834130
6. Yan D, Li J, Zhang Z, Zhu H (2012) Determination of cephazolin, ceftazidime, and ceftriaxone distribution
in nucleus pulposus. Arch Orthop Trauma Surg 132:969-976. PMID: 22526195
7. Riley LH, Banovac K, Martinez OV, Eismont FJ (1994) Tissue distribution of antibiotics in the
intervertebral disc. Spine 19:2619-25. PMID: 7899954
8. Rohde V, Meyer B, Schaller C, Hassler WE (1998) Spondylodiscitis after lumbar discectomy. Incidence and
a proposal for prophylaxis. Spine 23:615–620. PMID: 9530794
9. Eismont FJ, Wiesel SW, Brighton CT (1987) Antibiotic penetration into rabbit nucleus pulposus. Spine
12:254– 256. PMID: 3589822
10. Zhang L, Wang JC, Feng XM, Cai WH, Yang JD, Zhang N (2014). Antibiotic penetration into rabbit
nucleus pulposus with discitis. Eur J Orthop Surg Traumatol 24:453-458. doi: 10.1007/s00590-013-1317-8.
11. Scuderi GJ, Greenberg SS, Banovac K, Martinez OV, Eismont FJ (1993) Penetration of glycopeptide
antibiotics in nucleus pulposus. Spine 18:2039-2042. PMID: 8272956
12. Komatsu M, Takahata M, Sugawara M, Takekuma Y, Kato T (2010) Penetration of linezolid into rabbit
intervertebral discs and surrounding tissues. Eur Spine J 19:2149-2155. doi: 10.1007/s00586-010-1548-x.
13. Thomas Rde W, Batten JJ, Want S, McCarthy ID, Brown M, Hughes SP (1995) A new in-vitro model to
investigate antibiotic penetration of the intervertebral disc. J Bone Joint Surg Br 77:967–970. PMID: 7593116
14. Gibson MJ, Karpinski MR, Slack RC, Cowlishaw WA, Webb JK (1987) The penetration of antibiotics into
the normal intervertebral disc. J Bone Joint Surg Br 69:784–786. PMID: 3680343
15. Shanmugam S, Acharya LD, Mallayasamy SR, Rao A, Khan SA, Rajakannan T (2010) Study of tissue and
the plasma concentration of cefotaxime to assess its stability for prophylaxis in cholecystectomy. Journal of
Clinical and Diagnostic Research 4:2410-2415.
16. Walters R, Rahmat R, Fraser R, Moore R (2006) Preventing and treating discitis: cephazolin penetration in
ovine lumbar intervertebral disc. Eur Spine J 15.1397-1403. PMID: 16830132
17. El-Gindi S, Aref S, Salama M, Andrew J (1976) Infection of intervertebral discs after operation. J Bone
Joint Surg Br 58:114–116. PMID: 1270487
18. Hamdan TA (2012) Postoperative disc space infection after discectomy: A report on thirty-five patients. Int
Orthop 36: 445–450. doi: 10.1007/ s00264-011-1430-4.
19. Silber JS, Anderson DG, Vaccaro AR, Anderson PA, Mccormick P (2002) Management of post procedural
discitis. Spine J 2:279–287. PMID: 14589480
20. Sharma SK, Jones JO, Zeballos PP, Irwin SA, Martin TW (2009). The prevention of discitis during
discography. Spine J 9: 936-943. doi: 10.1016/j.spinee.2009.06.001
21. Snell RS, ed. (2012). Clinical anatomy by regions, 9th edition, Wolters Kluwer|Lippincott Williams&
Wilkins, Baltimore, Philadelphia.
22. Cai HX, Liu C, Fan SW (2011) Routinely using prophylactic antibiotic may not effectively prevent
intervertebral disc infection: a new strategy to preventing postoperative intervertebral disc infection. Med
hypothesis 76:464- 466. doi: 10.1016/j.mehy.2010.11.021.
23. Andrews JM (2001) Determination of minimum inhibitory concentrations. J Antimicrob Chemother 48
Suppl; 1:5-16. PMID: 11420333
24. Guiboux JP, Cantor JB, Small SD, Zervos M, Herkowitz HN (1995). The effect of prophylactic antibiotics
on iatrogenic intervertebral disc infections. a rabbit model. Spine 20:685-688. PMID: 7604344.
25. North American Spine Society, https://www.spine.org/ResearchClinicalCare/ClinicalGuidelines.aspx.
Clinical guidelines (2013).
26. Currier BL, Banovac K, Eismont FJ (1994) Gentamicin penetration into normal rabbit nucleus pulposus.
Spine 19:2614-2618. PMID: 7899953
27. Fraser RD, Osti OL, Vernon-Roberts B (1989) Iatrogenic discitis: the role of intravenous antibiotics in
prevention and treatment. An experimental Spine 14:1025-1032. PMID: 2781408
28. Köroğlu A, Acar O, Ustün ME, Tiraş B, Eser O (2001) The penetration of cefoperazone and sulbactam into
the lumbar intervertebral discs. J Spinal Discord 14:453-454. PMID: 1158614
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