994 ANTIBIOTIC TISSUE LEVELS IN PENILE PROSTHESIS SURGERY

Simplified, accurate method for antibiotic assay of clinical prophylactic antibiotics documented the advantage of prophylactic specimens. Applied Microbiol., 14: 170, 1966. antibiotics in prosthesis implantation, it has been widespread me&

11. Edberg, S. C. and Chu, A.: Determining antibiotic levels in the ical practice to administer antibiotics before prosthesis implantation. blood. h e r . J. Med. Technol., 41: 99, 1975. The effectiveness of these antibiotics depends on various character-

12. Jolley, M. E., Stroupe, S. D., Wang, C. J., Panas, H. N., Keegan, istics of the patient, surgical procedure and antibiotics. It is apparent C. L., Schmidt, R. L. and Sehwenzer. K. S.: Fluorescence from recent resea& that some bacterial pathogens produce a gly- polarization immunoassay. I. Monitoring aminoglycoside an- around implanted foreign bodies, which contains the bacteria tibiotics in serum and plasma. Clin. Chem., 27: 1190, 1981. and p r o m s them from natwal host defenses as well as from pr+

13. Daly, J. S., Eliopodos, G . M., Reiszner, E. and Moellering, R. c . , phylactic or therapeutic antibiotics. Similarly mme bacterial agents Jr.: Activity and mechanism of action of DuP 105 DuP 7% are more likely to colonize in prosthetic devices than others, requir- new oxazolidinone compounds. J. Antimicrob. Chemother., 21: ing specific antibiotics to target these offending organisms. With 721, 1988. penile prosthesis implantation gram-positive organisms are most

14. Takahata, M., Otsuki, M. and Nishino, T.: In-vitro and in-vivo of which S. epide-dis is the most frequent infectious activities of T-3262, a new pyridone carboxylic acid. J. Anti- agent in penile mese organisms as well as E, microb. Chemother., U: 143, 1988.

15, Watanab, N,, Katsu, K, Moriyama, M, and Kitoh, R: In vitro coli and Pseudomonas have an enhanced ability to produce the evaluation of E1040, a new cephalosporin with potent anti- glycocalix biofilm, which potentiates infectious ab pseudomonal activity, Antimicrob. Agents Chemother., 32: creases resistance to antibiotics. To decrease the possibility of colo-

nization and subsequent infection the use of prophylactic antibiotics 693, 1988. 16, wise, R,, A8hby, ,I, p, and Andrews, J, M.: In vitro activity of pD before surgery is critical. It is important for these antibiotics to be

127,391, an enbnced-spe&.,,m quinolone. Antimimob, present in the tissues a t levels in excess of the minimal inhibitory concentrations for the bacteria most likely to produce infection a t Agents Chemother., 32 1251, 1988.

17. [)an, M., Golomb, J., G ~ ~ ~ ~ , A,, ~ ~ f , 2, krger, s, A.: the time of incision. Therefore, the most important antibiotic is Concentration of ciprofloxacin in human prostatic tissue after that administered 1 to 2 hours before surgery. oral administration. AntimiLVob. Agents Chemother,, 30: 88, Schwartz et al evaluated tissue levels of 3 classes of agents fre- 1986. quently given for prophylaxis in penile prosthesis surgery. The com-

18. Matsumoto, T.. Kumazawa. J., Ueda, S., Eto, K., Yushita, Y., manly used combination of an aminoglYcoside and a P-lactam agent Saito, Y., Ishii. T. and Sawae, Y.: Treatment of complicated was compared to a fluoroquinolone. The fluoroquinolone was statis- urinary tract infections with ofloxacin following an aminogly- tically significantly higher in serum to corpus cavernosum tissue coside. Chemotherapy, suppl. 1, 37: 60, 1991. levels than the parenteral agents. This high tissue level has signif-

19. Walker, H. C. and Wright, A. J.: The fluoroquinolones. Mayo icant cost advantages, since these agents can be administered orally Clin. k., 66: 1249, 1991. with serum levels rising rapidly and attaining values similar to those

20. Walter% F. P., Neal, D. E., Jr., Rege, A. 8.. George, W. J., Ricci, of intravenous administration. The principal caveat to this prophy- M. J. and Hellstrom, W. J. C.: Cavernoua tiwue antibiotic laxis is the antibacterial spectrum of pathogens susceptible to fluo- levelo in penile prootheatie surgery. J. Urol., 147: 1282, 1992. roquinolones. While these agents have outstanding effectiveness for

21. Bishop, J. H.. Maul, J. W., Sihelnik, S. A., Peppas, D. s., susceptible gram-negative and gram-positive organisms, the im- GomloY. T. s. and M c I E d D. G.: Use of &codated hema- planting surgeon must be aware of the most common infections at dobin to identify diabetics at high risk for penile PeriPrOS- their medical center and the antibiotic resistance patterns of those thetic: infections. J. Urol., 147: 386, 1992. organisms. When fluoroquinolones appear to be effective for the most

22. Halkin, H.: Adverse effects of the fluoroquinolones. Rev. Infect. likely organisms, this class of agents clearly has high effective tissue levels and is more convenient for patient use. Therefore, the fluoro- D k suppl. 1, 10: 9258, 1988.

24. Gundemon. T. d.: Investment and innovation in urology. Piper quinolone antibiotics may provide a cost-effective method for prophylactic antibiotic administration in patients undergoing geni- Jaffray Hes. Newsletter, September 25, 1994.

tourinary prosthetic device implantation. Culley C. Carson, III University of North Carolina School of Medicine Chapel Hill, North Carolina

EDITORIAL COMMENT

Implantation of surgical devices and their behavior as foreign bodies have led to concerns of prwthesis infections. Since early stud& of implanting orthopedic prosthetic devices with and without