Chemoprophylaxis with cefoxitin and cephalothin in orthopedic surgery: A comparison

Forty-eight patients who underwent elective hip or knee surgery were randomly divided into two groups. A total of 22 patients received a single 1-g preoperative bolus of cefoxitin, and 26 patients received a single 1-g preoperative dose of cephalothin. At various time intervals, serum and bone samples were taken during the operative procedure. Our data indicated that whereas serum levels of cefoxitin and cephalothin were maintained for at least 2 h at levels capable of inhibiting most gram-positive cocci and many gram-negative rods, bone levels of cefoxitin only were sustained at therapeutic levels, and those of cephalothin showed a rather rapid decay over a 2-h period. Moreover, in only 58% of the entire cephalothin-treated group were bone levels detectable and then only at a concentration that would inhibit gram-positive cocci. No significant morbidity was observed in either treatment group.