From the *Pharmacology Depart- ment, University of Kragujevac, Kragujevac, Serbia and Montene- gro, Yugoslavia; †Clinic for Gy- necology and Obstetrics, Clinical Center, Kragujevac, Serbia and Montenegro, Yugoslavia; and ‡Clinic for Gynecology and Ob- stetrics, Clinical Center, Pod- gorica, Serbia and Montenegro, Yugoslavia. Supported by Serbian Ministry of Science and Ecology Grant 145005. Reprints: Slobodan Jankovic, Pharmacology Department, University of Kragujevac, Ul. Svetozara Markovica 69, 34000 Kragujevac, Serbia and Montene- gro, Yugoslavia. E-mail: slobnera@ eunet.yu. Copyright © 2007 by Lippincott Williams & Wilkins ISSN: 1542-5983/07/1306-0361 Case Series Serum and Uterine Concentrations of Cefazolin, Cefuroxime, and Ceftriaxone After Intraoperative Prophylactic Administration During Cesarean Section Slobodan M. Jankovic, MD, PhD, MA,* Mirjana Varjacic, MD, PhD,† and Snezana Crnogorac, MD, PhD‡ Abstract Objectives: Antibiotic prophylaxis of surgical site infections after urgent cesarean section is justified by the reduction of endometritis by two-thirds to three-quarters and a decrease in wound infections. However, not all antibiotics show adequate protec- tion. In our study, we compared pharmacokinetic profiles of 3 commonly used antibiotics for pro- phylaxis: cefazolin, cefuroxime, and ceftriaxone. Methods: A total of 60 patients were enrolled in the study, divided in 3 groups, each receiving dif- ferent antibiotic. Two gm cefazolin, 1.5 gm cefu- roxime, or 2 gm ceftriaxone were administered in 1 intravenous dose, immediately after clamping the umbilical cord. Results: Only concentrations of cefazolin mea- sured in serum from the cubital vein and uterine cavum samples were above minimal inhibitory concentrations of all susceptible common patho- gens for the whole intraoperative period. Cefazolin concentrations in blood from the uterine cavum were even higher than concentrations measured in blood from the cubital vein in the same time (10 minutes after intravenous injection): 89.0 mg/L versus 78.2 mg/L. Conclusions: The results of our study suggest a more suitable pharmacokinetic profile of cefazolin than that of cefuroxime and ceftriaxone for pro- phylaxis of surgical site infections after urgent ce- sarean section. Key Words: cesarean section, antibiotic prophy- laxis, surgical site infection, cefazolin (J Pelvic Med Surg 2007;13:361–365) P rophylactic administration of antibiotics during cesarean section is a well-defined medical procedure with proved benefits. 1 Its use in women undergoing cesarean section reduces the incidence of postoperative fever, endometritis, wound infection, and urinary tract infection. Majority of guidelines recom- mend prophylactic administration of either cefazolin or cefuroxime, 2,3 although ceftriax- one was once in use 4 ; both preoperative and intraoperative (after clamping umbilical cord) antibiotic administration give adequate protec- tion from postoperative infection. 5 In studies with some other cephalospo- rins (eg, cefbuperazone), it was shown that little difference existed in the serum concen- tration between cubital venous and uterine arterial serum, implying good tissue penetra- tion. 6 High placental transfer of cefuroxime was also shown through measurement of am- niotic fluid concentration of the drug in women undergoing cesarean section. 7 The same was shown with cefazolin, of which con- centrations in amniotic fluid were greater or equal to minimal inhibitory concentrations for the most common pathogens. 8 However, pen- etration of these antibiotics to the uterine ca- vum after delivery of placenta, and the time course of their serum concentrations after in- traoperative prophylactic administration of sin- gle dose were not studied. Better understand- ing of the concentrations reached during and after the cesarean section may give us an op- portunity to foresee effectiveness of prophy- laxis with cephalosporins in different settings, with different local microbial flora. The aim of our study was to measure concentrations of cefazolin, cefuroxime, and ceftriaxone in uterine cavum and venous blood, after their intraoperative prophylactic administration during cesarean section. 361 Journal of PELVIC MEDICINE & SURGERY Volume 13, Number 6 November/December 2007 DOI: 10.1097/SPV.0b013e31815a4479