Compared to oral decontamination and chemoprophylaxis, an intravenous prophylactic regimen as described above could be an effective and well-tolerated approach in prevention of bacterial infections and related complications, with a higher acceptance in recipients of bone marrow or stems cell grafts. Further evaluation in comparison with fluoroquinolone prophylaxis regarding efficacy, development of resistances as well as cost-benefit analyses is warranted.

The effect on 24-h gastric juice volume and pH of 30 min intravenous infusions of 200 and 400 mg oxmetidine and 50 mg ranitidine, administered at 6-hourly intervals, has been investigated in 12 healthy male subjects. After each infusion period a median intragastric pH greater than 5 was obtained with all active treatments, which also caused a significantly elevated 24-h median pH versus placebo. The 24-h median pH following ranitidine did not differ significantly from that after either oxmetidine treatment. There was a sharp decrease in gastric volume secretion within 2 h of infusion of each active treatment. There was no significant difference between active treatments in the time required to reach an intragastric pH greater than 5. No active treatment was able to maintain the pH greater than 5 for longer than 4 h (average 3 h). It is concluded that in patients at risk of stress ulcer, continuous infusion therapy with H2-blockers should be employed both for pharmacokinetic and practical reasons. It should be accompanied by regular measurement of pH in order to monitor any fall in pH. Alternatively, shorter time intervals than 6 h should be used for bolus therapy.

The efficacy of the perioperative short-term prophylaxis with cefotiam (CAS 66309-69-1) and cefuroxime axetil (CAS 64544-07-6) was analysed by the assessment of the pharmacological kinetics in the serum and the tonsil tissue in 50 patients with recurrent tonsillitis. Twenty-four patients received 1 g cefotiam by the intravenous route 30 min to 4 h before the tonsillectomy, and 26 patients received 250 mg cefuroxime axetil orally 1 to 6 h before the tonsillectomy. Bactericidal serum levels were reached for cefotiam up to 4 h after intravenous application and for cefuroxime axetil up to 3 h after oral application. In the tissue of the tonsil there were proved levels which were definitely above the MIC 90 (MIC = minimum inhibitory concentration) known for the clinically relevant germs for cefotiam after 30 min up to 2 h, for cefuroxime axetil after only 2 h. Considering the distribution areas, the capacity of the protein binding and the microbiological measuring methods, one can expect an efficient antibiotic coverage after an intravenous one-shot bolus injection of 1 g cefotiam from 30 min to 4 h and after oral application of 250 mg cefuroxime axetil on an empty stomach from 1 to 6 h. Because of the short duration of a tonsillectomy and the serum and tonsil tissue kinetics cefotiam and cefuroxime axetil are suitable for the perioperative antibiotic prophylaxis of high-risk patients.

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