Antibiotics are often administrated prophylactically in spinal procedures to reduce the risk of
infection of the disc space. It is still not known which
antibiotics are able to penetrate the intervertebral disc effectively. In a prospective, randomised, double-blind clinical study, we examined the penetration of the intervertebral discs of two commonly used
antibiotics,
cefuroxime and
gentamicin. The patients, randomised into two groups, received either 1.5 g of
cefuroxime or 5 mg/kg of
gentamicin prophylactically two hours before their intervertebral discs were removed. A specimen of blood, from which serum
antibiotic levels were determined, was obtained at the time of
discectomy. Therapeutic levels of
antibiotic were detectable in the intervertebral discs of the ten patients who received
gentamicin. Only two of the ten patients (20%) who received
cefuroxime had a quantifiable level of
antibiotic in their discs although therapeutic serum levels of
cefuroxime were found in all ten patients. Our results show that
cefuroxime does not diffuse into human intervertebral discs as readily as
gentamicin. It is possible that the charge due to ionisable groups on the
antibiotics can influence the penetration of the
antibiotics. We therefore recommend the use of
gentamicin in a single prophylactic dose for all spinal procedures in order to reduce the risk of
discitis.