Evidence map›Paper›PMID 28607871›Full record

ArticlePlastic and reconstructive surgery. Global open2017

Prevention of Surgical Site Infections and Biofilms: Pharmacokinetics of Subcutaneous Cefazolin and Metronidazole in a Tumescent Lidocaine Solution.

Jeffrey A Klein, Loralie J Langman

3 registry-linked trialsOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Plastic and reconstructive surgery. Global open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.2field-weighted citation impact, top 41% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03226626 phase2 / phase3unknown statusnot on this mapstarted 2021, after this paper: background citation

Tumescent Anesthesia Antibiotic Delivery (TAAD) and SubQKath for Prevention of Surgical Site Infection, Thrombosis and Sepsis

TypeinterventionalSponsorHK Surgical, Inc.Ran2021 to 2022Enrolled330ConditionsSurgical Site Infection, Thrombosis, SepsisArmsTumescent Anesthesia and antibiotic delivery (TAAD) plus IVAD, SubQKath
NCT03853096 early_phase1unknown statusnot on this mapstarted 2019, after this paper: background citation

Do Intra-incisional Subdermal Antibiotics Alter the Colony Count of P. Acnes

TypeinterventionalSponsorUniversity of British ColumbiaRan2019 to 2020Enrolled20ConditionsSurgical Site Infection, Microbial ColonizationArmsCefazolin
NCT04733781 phase2 / phase3unknown statusnot on this mapstarted 2021, after this paper: background citation

Subcutaneous Injection of Large Volumes of Tumescent Lidocaine and Epinephrine (TLE) by Laypersons: a Double-blind, Non-inferiority, Randomized Clinical Trial

TypeinterventionalSponsorJeffrey Alan Klein, MDRan2021 to 2021Enrolled36ConditionsVenomous Snakebites, Local Anesthesia, Painless Injection, Regional AnesthesiaArmsTumescent Lidocaine and Epinephrine
3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 3 citations in OpenAlex.

  1. When and How to Use Subcutaneous Antibiotics.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026
    Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

2 authors at 1 institution in 1 country.

Jeffrey A KleinDepartment of Dermatology, University of California, Irvine, School of Medicine, Irvine, Calif.; and Toxicology and Drug Monitoring Laboratory, Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn.
Loralie J LangmanDepartment of Dermatology, University of California, Irvine, School of Medicine, Irvine, Calif.; and Toxicology and Drug Monitoring Laboratory, Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn.
Mayo Clinic · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTumescent anesthesia antibiotic delivery (TAAD) consists of subcutaneous infiltration of antibiotic(s) dissolved tumescent lidocaine anesthesia. Tumescent lidocaine anesthesia contains lidocaine (≤ 1 g/L), epinephrine (≤ 1 mg/L), sodium bicarbonate (10 mEq/L) in 0.9% saline. Our aim was to measure cefazolin and metronidazole concentrations over time in subcutaneous tumescent interstitial fluid (TISF) after TAAD, in serum after TAAD and after intravenous antibiotic delivery (IVAD). We hypothesize that the pharmacokinetic/pharmacodynamic profiles of TAAD + IVAD are superior to IVAD alone for the prevention of surgical site infections and biofilms.

methodsConcentrations of cefazolin and metronidazole in TISF and serum following TAAD and in serum following IVAD were compared in 5 female volunteers. Subjects received cefazolin or cefazolin plus metronidazole by IVAD alone and by TAAD alone. One subject also received concomitant IVAD and TAAD of these 2 antibiotics. Sequential samples of serum or subcutaneous TISF were assayed for antibiotic concentration.

resultsCefazolin (1 g) by TAAD resulted in an area under the curve of the concentration-time profile and a maximum concentration (Cmax) in subcutaneous tissue that were 16.5 and 5.6 times greater than in serum following 1 g by IVAD. Metronidazole (500 mg) by TAAD resulted in an area under the curve and Cmax that were 8.1 and 24.7 times greater in TISF, than in serum after 500 mg by intravenous delivery. IVAD + TAAD resulted in superior antibiotic concentrations to IVAD alone.

conclusionsTAAD + IVAD produced superior antibiotic bioavailability in both subcutaneous interstitial fluid and serum compared with IVAD alone. There was no evidence that TAAD of cefazolin and metronidazole poses a significant risk of harm to patients.

Identifiers

PMID28607871
PMCPMC5459654
OpenAlexW2617912548

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.