Spine. 2003 Aug 1;28(15):1735-8.
The use of intradiscal antibiotics for discography: an in vitro study of
gentamicin, cefazolin, and clindamycin.
Klessig HT, Showsh SA, Sekorski A.
Pain Clinic of Northwestern Wisconsin, Eau Claire, Wisconsin 54702, USA.
[email protected]
STUDY DESIGN: In vitro determination of minimum inhibitory concentrations (MICs)
of gentamicin, cefazolin, and clindamycin, alone and in combination with iohexol
against laboratory strains of Eschericia coli B, Staphylococcus aureus, and
Staphylococcus epidermidis. OBJECTIVE: To study the effects of iohexol on the
efficacy of gentamicin, cefazolin, and clindamycin. SUMMARY OF BACKGROUND DATA:
Prophylactic antibiotics have been advocated to prevent discitis following
discography. Intravenous cefazolin administered before discography has been
shown to penetrate the intervertebral disc. However, the use of systemic
antibiotics for prophylaxis may lead to bacterial resistance. Intradiscal
antibiotic administration is an attractive alternative to systemic antibiotic
prophylaxis before discography, but there is no data documenting the efficacy of
commonly used antibiotics in the presence of iohexol. METHODS: MICs were
determined by adding standard concentrations of bacteria to serial dilutions of
antibiotic with and without the addition of iohexol in Todd-Hewitt Broth medium.
MICs were determined as the lowest concentration well that demonstrated
inhibition of cell growth. RESULTS: Gentamicin, cefazolin, and clindamycin
remain efficacious in the presence of iohexol. MICs were lower for cefazolin and
gentamycin than for clindamycin. Iohexol alone also demonstrated some inhibition
of cell growth. CONCLUSION: This study supports the use of intradiscal
antibiotics for prophylaxis of disc space infection during discography.
lntradiscal placement of antibiotic should obviate the need for systemic
antibiotic prophylaxis and its attendant risk of generating antimicrobial
resistance.
J Bone Joint Surg Br. 1990 Mar;72(2):271-4.
Discitis after discography. The role of prophylactic antibiotics.
Osti OL, Fraser RD, Vernon-Roberts B.
Spinal Service and Spinal Injuries Unit, Royal Adelaide Hospital, South
Australia.
Discitis after discography is due to bacterial penetration into the
intervertebral disc by a contaminated needle and has an incidence of 1% to 4%.
We have examined the prophylactic role of cephazolin administered at the time of
discography. An experimental study in sheep using radiographic contrast
containing Staphylococcus epidermidis showed that either adding the antibiotic
to the intradiscal suspension or giving it intravenously 30 minutes before
intradiscal inoculation of bacteria prevented any radiographic, macroscopic or
histological signs of discitis; all the intervertebral disc cultures were
negative. In a prospective clinical study of 127 consecutive patients having
lumbar discography, the injected contrast contained cephazolin 1 mg per ml. None
of the patients developed clinical or radiographic signs of discitis. We
recommend the use of a suitable broad spectrum antibiotic in a single
prophylactic dose whenever the intervertebral disc is entered.
