To the Editor.—The report by Fry and Pitcher1 in the November 1990 issue of the Archives emphasizes the importance of adequate levels of an antibiotic in the serum and operative wound for prophylaxis against infection. They show the rapid decline in the concentration of cephalothin in the wound within 1 hour of preoperative intravenous administration.
Since the concentration of an antibiotic plays an important role in its effectiveness, let me suggest that our studies2,3 show that intraoperative antibiotic irrigation, repeated at intervals of 3 to 10 minutes, maintains a concentration of cephalothin (1000 mg/L of normal saline) that is many times the level obtained with preoperative intravenous administration. Furthermore, the level is maintained throughout the procedure, whether it lasts 1 hour or 4 or more hours.
LORD JW. Antibiotic Prophylaxis. Arch Surg. 1991;126(5):656. doi:10.1001/archsurg.1991.01410290134030