Efficacy of limited cefuroxime prophylaxis in pediatric patients after cardiovascular surgery

Knoderer, Chad A.; Cox, Elaine G.; Berg, Michelle D.; Webster, Andrea H.; Turrentine, Mark W.

doi:10.2146/ajhp100563

Cited by 9 publications

(9 citation statements)

References 16 publications

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“…After a careful search for references, we identified an additional 8 of 48 papers relevant for the analysis. After the removal of duplicates, exclusion of reports other than original papers or reviews, and reports that did not fulfill the inclusion criteria, we identified 20 publications for the final analysis [1][2][3][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Detailed information included in these 20 papers is provided in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Murray et al point to the fact that after a strict schedule implementation, timing of antibiotic prophylaxis was not proper in about 20% of patients, 27% of patients did not receive appropriate intra-operative redosing, and 84% had inadequate post-operative doses [17]. Surprisingly, after the implementation of an antibiotic prophylaxis protocol in this special group of patients, some authors observe that additional antibiotics for empirical treatment are initiated more often after the intervention than before (26.9% vs. 18.6%, respectively) [12]. It is to be hoped that this is a transient phenomenon, as implementation of proper tools for diagnosing infections with accurate interpretation is essential.…”

Section: Discussionmentioning

confidence: 97%

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Antibiotic Prophylaxis in Pediatric Cardiac Surgery: Where Are We and Where Do We Go? A Systematic Review

Jaworski

Kansy

Dzierżanowska-Fangrat

et al. 2019

Surgical Infections

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Background: Prophylactic antibiotic therapy is given routinely in the peri-operative period to prevent surgical site infection. However, in pediatric cardiac surgery, an optimal schedule has not been defined. Pediatric recommendations follow the guidelines for adults, which might be improper because of the inherent challenges in pediatric research and the heterogeneity of the population. Implementation of an effective prophylaxis protocol is needed for children undergoing cardiac surgery, especially in view of worldwide antibiotic overuse and the development of drug resistance. In this review, we analyze the current knowledge supported by up-todate publications about antibiotic prophylaxis in pediatric cardiac surgery. Methods: The PubMed Ò database was searched for full-text journal articles describing peri-operative antibiotic prophylaxis in pediatric cardiac surgery published since 2000. Antibiotics used for standard prophylaxis with dosing schema, time of the first dose, additional dosage in extracorporeal circulation (ECC) priming, and prophylaxis duration were analyzed. Additionally, we looked for special clinical situations such as antibiotic prophylaxis in children with the sternum left open after surgery and patients with b-lactam allergy or preoperative methicillin-resistant Staphylococcus aureus (MRSA) colonization or those requiring extracorporeal membrane oxygenation (ECMO). Results: A total of 1,546 articles were evaluated, and we identified 20 for further analysis. On the basis of the current peri-operative antibiotic prophylaxis recommendations for cardiac surgery and the papers reviewed, we tried to propose a schedule for peri-operative antibiotic prophylaxis in pediatric cardiac surgery. Conclusions: There is a need for careful use and examination of the schedule proposed because the pharmacokinetics of antibiotics in pediatric patients with ECC is not fully understood. This should be evaluated further. Formulating uniform recommendations concerning peri-operative antibiotic prophylaxis is difficult.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 97%

Antibiotic Prophylaxis in Pediatric Cardiac Surgery: Where Are We and Where Do We Go? A Systematic Review

Jaworski

Kansy

Dzierżanowska-Fangrat

et al. 2019

Surgical Infections

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“…Bi et al [18] characterized pathogens and their antibiotic susceptibility in 895 isolated obtained from children with urinarytract infections caused by catheter indwelling in order to optimize prophylaxis. Escherichia coli was the most frequent pathogen, followed by Staphylococcus aureus, Staphylococcus epidermidis, and Enterococcus species.…”

Section: Cefuroxime and Cefuroxime Axetil Prophylaxis For Urinarytract Infection And Surgery In Infants And Childrenmentioning

confidence: 99%

Clinical pharmacology of cefuroxime and cefuroxime axetil in infants and children

Pacifici¹

2020

Clin Med Invest

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Cefuroxime is a second-generation cephalosporin β-lactamase resistant active against gram-negative and gram-positive organisms and the prodrug cefuroxime axetil is the drug of choice for treatment of Lyme disease. Cefuroxime inhibits bacterial cell wall synthesis, is bactericidal, and is one of the few cephalosporins available for oral, intravenous, and intramuscular administration. Cefuroxime is rapidly absorbed when given by mouth, and its blood concentrations remarkably vary among subjects, but the drug has not adverse-effects even when is given at high doses. The gastrointestinal absorption-rate of cefuroxime axetil is 70%, and after hydrolysis it relays cefuroxime. Parenteral dosing-regimens consist of 25 mg/kg in infants and dosing intervals decrease with increasing postnatal age. Cefuroxime oral dosingregimens are: 10, 20 mg/kg and 250 mg twice-daily in children aged up to one year, 2 to 11 and 12 to 17 years, respectively. Elimination half-live are: 6 hours in the first week of life and 1.8 hours in children aged up to 6 years. Cefuroxime is efficacy and safe for prophylaxis and treatment of respiratory-tract and acute urinary-tract infections, pneumoniae, acute otitis media, and sinusitis in children. Prophylaxis for surgical procedures requires 50 mg/kg before procedure and then 30 mg/kg for up 3 days after intervention. Cefuroxime concentration in cerebrospinal fluid is about 10% of that in plasma and the drug successfully treated meningitis caused by β-haemolytic streptococci, Streptococcus pneumoniae, and Neisseria meningitides, but when Salmonella species are the infective pathogens additional 5 mg dose is given intraventricularly. Some bacteria may become resistant to cefuroxime and antibiotic consumption is associated with increased bacterial-resistance. The aim of this study is to review the published data on cefuroxime and cefuroxime axetil dosing, efficacy, safety, and cefuroxime effects, prophylaxis, treatment, optimization, meningitis, pharmacokinetics and bacterial-resistance.

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“…A European point prevalence survey in 2008 showed that 67% of children and neonates in the study received surgical prophylaxis for more than a 24-hour period [23]. The above is worrying if we consider that not only does prolong surgical prophylaxis prevent surgical site infections, but, contrary to that, it can increase the risk of infections by multidrug-resistant pathogens [24, 25].…”

Section: Characteristics and Particularities Of Antimicrobial Prescrimentioning

confidence: 99%

Antimicrobial Stewardship in the Neonatal Intensive Care Unit: An Update

Gkentzi

Dimitriou

2019

CPR

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Neonates represent a vulnerable population for infections and neonatal sepsis is a major cause of mortality and morbidity worldwide. Therefore, antimicrobials are the most commonly pre-scribed drugs in the Neonatal Intensive Care Unit Setting but unfortunately are quite often used inap-propriately with various short and long-term effects. The rational use of antimicrobials is of para-mount importance in this population and structured antimicrobial stewardship interventions should be in place. These interventions are slightly different from those used in adults and older children due to the particularities of the neonatal medicine. The aim of this review is to provide an update in the field and identify areas for further consideration and future research

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Efficacy of limited cefuroxime prophylaxis in pediatric patients after cardiovascular surgery

Cited by 9 publications

References 16 publications

Antibiotic Prophylaxis in Pediatric Cardiac Surgery: Where Are We and Where Do We Go? A Systematic Review

Antibiotic Prophylaxis in Pediatric Cardiac Surgery: Where Are We and Where Do We Go? A Systematic Review

Clinical pharmacology of cefuroxime and cefuroxime axetil in infants and children

Antimicrobial Stewardship in the Neonatal Intensive Care Unit: An Update

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