Tissue penetration of antimicrobials: Difference between revisions
From IDWiki
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!Blood |
!Blood |
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!CNS |
!CNS |
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!Vitreous |
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!Urine |
!Urine |
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!Prostate |
!Prostate |
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!Necrotic |
!Necrotic |
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|- |
|- |
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! colspan=" |
! colspan="8" |Antibiotics: β-Lactams |
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|- |
|- |
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| rowspan="3" |[[Penicillins]] |
| rowspan="3" |[[Penicillins]] |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" |– |
| style="text-align:center" |– |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | + |
| style="text-align:center" | + |
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| style="text-align:center" |± |
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| style="text-align:center" | |
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| style="text-align:center" | |
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Line 28: | Line 31: | ||
|[[piperacillin-tazobactam]] |
|[[piperacillin-tazobactam]] |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" |– |
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| style="text-align:center" |– |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | +† |
| style="text-align:center" | +† |
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| style="text-align:center" | |
| style="text-align:center" | |
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|- |
|- |
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| rowspan=" |
| rowspan="6" |[[Cephalosporins]] |
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|first-generation cephalosporins |
|first-generation cephalosporins |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" |– |
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| style="text-align:center" |– |
| style="text-align:center" |– |
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| style="text-align:center" | |
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Line 44: | Line 49: | ||
| style="text-align:center" | |
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| style="text-align:center" |– |
| style="text-align:center" |– |
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| style="text-align:center" | |
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Line 51: | Line 57: | ||
| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" |± |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | +† |
| style="text-align:center" | +† |
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| style="text-align:center" | |
| style="text-align:center" | |
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|- |
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|[[ceftriaxone]] |
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| |
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| + |
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| |
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| |
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| |
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| |
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|- |
|- |
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|[[cefepime]] |
|[[cefepime]] |
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| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
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Line 65: | Line 81: | ||
| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | + |
| style="text-align:center" | + |
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| style="text-align:center" |± |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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Line 73: | Line 90: | ||
| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" |– |
| style="text-align:center" |– |
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| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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Line 78: | Line 96: | ||
|- |
|- |
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|[[cefoxitin]] |
|[[cefoxitin]] |
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| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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Line 84: | Line 103: | ||
| style="text-align:center" |– |
| style="text-align:center" |– |
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|- |
|- |
||
|[[Carbapenems]] |
| rowspan="2" |[[Carbapenems]] |
||
|[[imipenem]] |
|[[imipenem]] |
||
| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
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| style="text-align:center" | |
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| style="text-align:center" | |
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| style="text-align:center" | + |
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|- |
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|[[meropenem]] |
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| style="text-align:center" | |
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| style="text-align:center" | + |
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| style="text-align:center" | + |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | + |
| style="text-align:center" | + |
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|- |
|- |
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! colspan=" |
! colspan="8" |Antibiotics: Non-β-Lactams |
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|- |
|- |
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|[[Aminoglycosides]] |
|[[Aminoglycosides]] |
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| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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Line 104: | Line 133: | ||
|[[Chloramphenicol]] |
|[[Chloramphenicol]] |
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|[[chloramphenicol]] |
|[[chloramphenicol]] |
||
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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Line 110: | Line 140: | ||
| style="text-align:center" | + |
| style="text-align:center" | + |
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|- |
|- |
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|[[Fluoroquinolones]] |
| rowspan="2" |[[Fluoroquinolones]] |
||
|all |
|||
| style="text-align:center" | |
|||
| style="text-align:center" | |
| style="text-align:center" | |
||
| style="text-align:center" |–? |
| style="text-align:center" |–? |
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| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | + |
| style="text-align:center" | + |
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| style="text-align:center" | + |
| style="text-align:center" | + |
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|- |
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|[[moxifloxacin]] |
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| |
|||
| |
|||
| |
|||
|– |
|||
| |
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| |
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|- |
|- |
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|[[Fosfomycin]] |
|[[Fosfomycin]] |
||
|[[fosfomycin]] |
|[[fosfomycin]] |
||
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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Line 130: | Line 170: | ||
| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" |– |
| style="text-align:center" |– |
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| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | + |
| style="text-align:center" | + |
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|- |
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|[[Lipopeptides]] |
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|[[daptomycin]] |
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| style="text-align:center" | + |
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| style="text-align:center" |– |
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| style="text-align:center" | |
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| style="text-align:center" | + |
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| style="text-align:center" | |
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| style="text-align:center" | |
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|- |
|- |
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|[[Macrolides]] |
|[[Macrolides]] |
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Line 138: | Line 188: | ||
| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" |– |
| style="text-align:center" |– |
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| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | + |
| style="text-align:center" | + |
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Line 144: | Line 195: | ||
|[[Nitrofurans]] |
|[[Nitrofurans]] |
||
|[[nitrofurantoin]] |
|[[nitrofurantoin]] |
||
| style="text-align:center" |– |
|||
| style="text-align:center" |– |
| style="text-align:center" |– |
||
| style="text-align:center" |– |
| style="text-align:center" |– |
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Line 152: | Line 204: | ||
|[[Nitroimidazoles]] |
|[[Nitroimidazoles]] |
||
|[[metronidazole]] |
|[[metronidazole]] |
||
| style="text-align:center" | |
|||
| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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Line 157: | Line 210: | ||
| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | + |
| style="text-align:center" | + |
||
|- |
|||
|[[Oxazolidinones]] |
|||
|[[linezolid]] |
|||
| style="text-align:center" | + |
|||
| style="text-align:center" | + |
|||
| style="text-align:center" | + |
|||
| style="text-align:center" |±‡ |
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| style="text-align:center" | |
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| style="text-align:center" | |
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|- |
|- |
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|[[Rifamycins]] |
|[[Rifamycins]] |
||
|[[rifampin]] |
|[[rifampin]] |
||
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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Line 168: | Line 231: | ||
|[[Sulfonamides]] |
|[[Sulfonamides]] |
||
|[[trimethoprim-sulfamethoxazole]] |
|[[trimethoprim-sulfamethoxazole]] |
||
| style="text-align:center" | |
|||
| style="text-align:center" | |
| style="text-align:center" | |
||
| style="text-align:center" | |
| style="text-align:center" | |
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Line 178: | Line 242: | ||
| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" |– |
| style="text-align:center" |– |
||
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | + |
| style="text-align:center" | + |
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Line 186: | Line 251: | ||
| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" |±[[CiteRef::jodlowski2020do]] |
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| style="text-align:center" | + |
| style="text-align:center" | + |
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| style="text-align:center" | + |
| style="text-align:center" | + |
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|- |
|- |
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! colspan=" |
! colspan="8" |Antivirals |
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|- |
|- |
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| |
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|[[Azoles]] |
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|[[acyclovir]] / [[valacyclovir]] |
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| style="text-align:center" | |
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| style="text-align:center" | |
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| style="text-align:center" | + |
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| style="text-align:center" | |
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| style="text-align:center" | |
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| style="text-align:center" | |
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|- |
|||
| |
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|[[ganciclovir]] |
|||
| style="text-align:center" | |
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| style="text-align:center" | |
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| style="text-align:center" | + |
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| style="text-align:center" | |
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| style="text-align:center" | |
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| style="text-align:center" | |
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|- |
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| |
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|[[foscarnet]] |
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| style="text-align:center" | |
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| style="text-align:center" | |
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| style="text-align:center" | |
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| style="text-align:center" | |
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| style="text-align:center" | |
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| style="text-align:center" | |
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|- |
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! colspan="8" |Antifungals[[CiteRef::felton2014ti]] |
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|- |
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| rowspan="3" |[[Azoles]] |
|||
|[[fluconazole]] |
|[[fluconazole]] |
||
| style="text-align:center" | |
| style="text-align:center" | |
||
| style="text-align:center" | + |
|||
| style="text-align:center" | + |
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| style="text-align:center" | + |
|||
| style="text-align:center" |± |
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| style="text-align:center" | + |
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|- |
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|[[itraconazole]] |
|||
| style="text-align:center" | |
| style="text-align:center" | |
||
| style="text-align:center" |± |
|||
| style="text-align:center" |– |
|||
| style="text-align:center" | + |
|||
| style="text-align:center" |– |
|||
| style="text-align:center" | |
| style="text-align:center" | |
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|- |
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|[[voriconazole]] |
|||
| style="text-align:center" | |
| style="text-align:center" | |
||
| style="text-align:center" |± |
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| style="text-align:center" |± |
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| style="text-align:center" |± |
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| style="text-align:center" | |
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| style="text-align:center" | |
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|- |
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| rowspan="3" |[[Echinocandins]] |
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|[[anidulafungin]] |
|||
| style="text-align:center" | + |
| style="text-align:center" | + |
||
| style="text-align:center" |± |
|||
| style="text-align:center" |– |
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| style="text-align:center" |± |
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| style="text-align:center" | |
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| style="text-align:center" | |
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|- |
|- |
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|[[ |
|[[caspofungin]] |
||
| style="text-align:center" | + |
|||
| style="text-align:center" |– |
|||
| style="text-align:center" |– |
|||
| style="text-align:center" |± |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
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|- |
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|[[micafungin]] |
|||
| style="text-align:center" | |
|||
| style="text-align:center" |± |
|||
| style="text-align:center" |– |
|||
| style="text-align:center" |± |
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| style="text-align:center" | |
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| style="text-align:center" | |
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|- |
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| rowspan="2" |[[Polyenes]] |
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|deoxycholate [[amphotericin B]] |
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| style="text-align:center" | |
|||
| style="text-align:center" | |
|||
| style="text-align:center" |– |
|||
| style="text-align:center" | + |
| style="text-align:center" | + |
||
| style="text-align:center" | |
|||
| style="text-align:center" | |
|||
|- |
|||
|liposomal [[amphotericin B]] |
|||
| style="text-align:center" | |
| style="text-align:center" | |
||
| style="text-align:center" |– |
| style="text-align:center" |– |
||
| style="text-align:center" |±† |
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| style="text-align:center" | + |
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| style="text-align:center" | |
| style="text-align:center" | |
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| style="text-align:center" | |
| style="text-align:center" | |
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Line 211: | Line 357: | ||
!Blood |
!Blood |
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!CNS |
!CNS |
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!Vitreous |
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!Urine |
!Urine |
||
!Prostate |
!Prostate |
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Line 217: | Line 364: | ||
*† if inflammation present |
*† if inflammation present |
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*‡ very low levels, but likely enough for [[Enterococcus]] |
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==Specific Tissues== |
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==Prostate== |
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=== Central Nervous System === |
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* Reviewed in [[CiteRef::nau2010pe]] |
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{| class="wikitable" |
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!Class |
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!Antimicrobial |
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!CSF Penetration (AUC) |
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!With Meningeal Inflammation |
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|- |
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! colspan="4" |Antibiotics |
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|- |
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| rowspan="5" |[[penicillins]] |
|||
|overall |
|||
|2% |
|||
|2% |
|||
|- |
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|[[ampicillin]] |
|||
| |
|||
| |
|||
|- |
|||
|[[amoxicillin]] |
|||
| |
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|6% |
|||
|- |
|||
|[[cloxacillin]] |
|||
|0.87% |
|||
| |
|||
|- |
|||
|[[piperacillin]] |
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|3% |
|||
|32% |
|||
|- |
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| rowspan="3" |beta lactamase inhibitors |
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|overall |
|||
|7% |
|||
|10% |
|||
|- |
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|[[clavulanate]] |
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|4% |
|||
|8% |
|||
|- |
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|[[tazobactam]] |
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|11% |
|||
| |
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|- |
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| rowspan="4" |[[cephalosporins]] |
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|overall |
|||
|0.7 to 10% |
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|15% |
|||
|- |
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|[[cefotaxime]] |
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|12% |
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|4 to 17% |
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|- |
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|[[ceftriaxone]] |
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|0.7% |
|||
| |
|||
|- |
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|[[ceftazidime]] |
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|0.6% |
|||
| |
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|- |
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| rowspan="3" |[[carbapenems]] |
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|overall |
|||
|20% |
|||
|30% |
|||
|- |
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|imipenem |
|||
| |
|||
|14% |
|||
|- |
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|meropenem |
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|5 to 25% |
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|39% |
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|- |
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|[[aminoglycosides]] |
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|overall |
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|20% |
|||
| |
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|- |
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| rowspan="4" |[[fluoroquinolones]] |
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|overall |
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|30 to 70% |
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|70 to 90% |
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|- |
|||
|[[ciprofloxacin]] |
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|24 to 43% |
|||
|92% |
|||
|- |
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|[[levofloxacin]] |
|||
|71% |
|||
| |
|||
|- |
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|[[moxifloxacin]] |
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|46% |
|||
|79% |
|||
|- |
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|[[chloramphenicol]] |
|||
| |
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|60 to 70% |
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|60 to 70% |
|||
|- |
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|[[macrolides]] |
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|[[clarithromycin]] |
|||
| |
|||
|18% |
|||
|- |
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|[[tetracyclines]] |
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|[[doxycycline]] |
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|20% |
|||
|20% |
|||
|- |
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|[[fosfomycin]] |
|||
| |
|||
|18% |
|||
| |
|||
|- |
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|[[linezolid]] |
|||
|90% |
|||
| |
|||
| |
|||
|- |
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|[[metronidazole]] |
|||
| |
|||
| |
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|87% |
|||
|- |
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|[[rifamycins]] |
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|[[rifampin]] |
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|22% |
|||
| |
|||
|- |
|||
|[[trimethoprim-sulfamethoxazole]] |
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|[[trimethoprim]] |
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|18% |
|||
|42 to 51% |
|||
|- |
|||
| |
|||
|[[sulfamethoxazole]] |
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|12% |
|||
|24 to 30% |
|||
|- |
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|[[glycopeptides]] |
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|[[vancomycin]] |
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|14 to 18% |
|||
|30% |
|||
|- |
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|antituberculosis medications |
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|[[isoniazid]] |
|||
| |
|||
|86% |
|||
|- |
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! colspan="4" |Antivirls |
|||
|- |
|||
| rowspan="2" |anti-herpes nucleoside analogues |
|||
|[[acyclovir]] |
|||
|31% |
|||
| |
|||
|- |
|||
|[[valacyclovir]] |
|||
|19% |
|||
| |
|||
|- |
|||
|[[foscarnet]] |
|||
| |
|||
|27 to 43% |
|||
|23 to 66% |
|||
|- |
|||
| rowspan="4" |HIV antiretrovirals |
|||
|[[abacavir]] |
|||
|35% |
|||
| |
|||
|- |
|||
|[[zidovudine]] |
|||
|75% |
|||
| |
|||
|- |
|||
|[[indinavir]] |
|||
|6 to 15% |
|||
| |
|||
|- |
|||
|[[lopinavir]] |
|||
|29% |
|||
| |
|||
|- |
|||
! colspan="4" |Antifungals |
|||
|- |
|||
| |
|||
|[[flucytosine]] |
|||
| |
|||
|74% |
|||
|- |
|||
| rowspan="2" |[[azoles]] |
|||
|[[fluconazole]] |
|||
| |
|||
|86% |
|||
|- |
|||
|[[voriconazole]] |
|||
| |
|||
|46% |
|||
|- |
|||
|[[polyenes]] |
|||
|[[amphotericin B]] |
|||
| |
|||
|low |
|||
|- |
|||
! colspan="4" |Antiparasitics |
|||
|- |
|||
| |
|||
|[[albendazole]] |
|||
|38 to 43% |
|||
| |
|||
|- |
|||
| |
|||
|[[praziquantel]] |
|||
|24% |
|||
| |
|||
|- |
|||
| |
|||
|[[sulfadiazine]] |
|||
|27 to 33% |
|||
| |
|||
|} |
|||
===Prostate=== |
|||
*Poorly penetrated by most antibiotics |
*Poorly penetrated by most antibiotics |
||
Line 228: | Line 602: | ||
*[[Piperacillin]], [[aztreonam]], [[imipenem]], and some [[aminoglycosides]] are likely useful |
*[[Piperacillin]], [[aztreonam]], [[imipenem]], and some [[aminoglycosides]] are likely useful |
||
== |
===Bone=== |
||
* |
*Essentially all antibiotics achieve similar bone-to-serum levels, with the exception of oral β-lactams which nevertheless have no worse outcomes[[CiteRef::landersdorfer2009pe]] |
||
===Eye=== |
|||
*Ocular compartments include anterior and posterior |
|||
**Anterior includes aqeous humour, and is best accessed using topical medications |
|||
**Posterior includes vitreous humour, retina, and choroid, and is best accessed using intravitreal or systemic medications |
|||
*Penetration of systemic antimicrobials into retina and vitreous is poor (~0 to 2%), but is better with inflammation[[CiteRef::brockhaus2019re]] |
|||
**Preferred agents for vitreal penetration include [[meropenem]], [[linezolid]], and [[moxifloxacin]] |
|||
**Agents that are likely effective, especially when inflammation is present, include [[vancomycin]], [[cefazolin]], [[ceftriaxone]], [[ceftazidime]], [[imipenem]], and [[trimethoprim-sulfamethoxazole]], and possible [[daptomycin]] and [[rifampin]] |
|||
**Agents that do not reach adequate levels include [[ciprofloxacin]], [[levofloxacin]], [[aminoglycosides]], [[aminopenicillins]], [[piperacillin]], [[cefepime]], and [[clarithromycin]] |
|||
{| class="wikitable" |
|||
!Class |
|||
!Antimicrobial |
|||
!Retinal Penetration |
|||
!Vitreal Penetration |
|||
!Ref |
|||
|- |
|||
! colspan="5" |Antibiotics |
|||
|- |
|||
| rowspan="3" |[[penicillins]] |
|||
|[[ampicillin]] |
|||
| |
|||
|below MIC in non-inflamed rabbit eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
|[[amoxicillin]] |
|||
| |
|||
|2% (below MIC) in non-inflamed rabbit eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
|[[piperacillin]] |
|||
| |
|||
|undetectable in inflamed human eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
| rowspan="4" |[[cephalosporins]] |
|||
|[[cefazolin]] |
|||
| |
|||
|above MIC in inflamed rabbit eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
|[[ceftriaxone]] |
|||
| |
|||
|4% in non-inflamed human eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
|[[ceftazidime]] |
|||
| |
|||
|30% in inflamed rabbit eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
|[[cefipime]] |
|||
| |
|||
|8% in non-inflamed human eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
| rowspan="2" |[[carbapenems]] |
|||
|[[imipenem]] |
|||
| |
|||
|8 to 10% in non-inflamed human eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
|[[meropenem]] |
|||
| |
|||
|30% in non-inflamed human eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
|[[oxazolidinones]] |
|||
|[[linezolid]] |
|||
| |
|||
|30 to 80% in non-inflamed human eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
| |
|||
|[[vancomycin]] |
|||
| |
|||
|above MIC in inflamed rabbit eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
| |
|||
|[[daptomycin]] |
|||
| |
|||
|30% in inflamed human eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
| rowspan="2" |[[aminoglycosides]] |
|||
|[[amikacin]] |
|||
| |
|||
|below MIC in inflamed rabbit eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
|[[gentamicin]] |
|||
| |
|||
|below MIC in inflamed rabbit eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
| rowspan="3" |[[fluoroquinolones]] |
|||
|[[ciprofloxacin]] |
|||
| |
|||
|below MIC in non-inflamed human eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
|[[levofloxacin]] |
|||
| |
|||
|30% but below MIC in non-inflamed human eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
|[[moxifloxacin]] |
|||
| |
|||
|10 to 40% and above MIC in non-inflamed human eyes |
|||
|[[CiteRef::brockhaus2019re]] |
|||
|- |
|||
! colspan="5" |Antifungals |
|||
|- |
|||
| rowspan="4" |[[azoles]] |
|||
|[[fluconazole]] |
|||
|40 to 50% |
|||
|40 to 50% |
|||
|[[CiteRef::suzuki2008oc]][[CiteRef::felton2014ti]] |
|||
|- |
|||
|[[itraconazole]] |
|||
| |
|||
|10% in inflamed eyes |
|||
|[[CiteRef::felton2014ti]] |
|||
|- |
|||
|[[posaconazole]] |
|||
| |
|||
|20% in inflamed eyes |
|||
|[[CiteRef::felton2014ti]] |
|||
|- |
|||
|[[voriconazole]] |
|||
| |
|||
|40 to 100% |
|||
|[[CiteRef::felton2014ti]] |
|||
|- |
|||
| |
|||
|[[flucytosine]] |
|||
| |
|||
|40 to 100% |
|||
|[[CiteRef::felton2014ti]] |
|||
|- |
|||
|[[polyenes]] |
|||
|liposomal amphotericin B |
|||
| |
|||
|only detectable in inflamed eyes |
|||
|[[CiteRef::felton2014ti]] |
|||
|- |
|||
| rowspan="2" |[[echinocandins]] |
|||
|echinocandins |
|||
| |
|||
|very low penetration |
|||
|[[CiteRef::felton2014ti]] |
|||
|- |
|||
|[[micafungin]] |
|||
|excellent |
|||
|undetectable |
|||
|[[CiteRef::suzuki2008oc]][[CiteRef::felton2014ti]] |
|||
|- |
|||
! colspan="5" |Antivirals |
|||
|- |
|||
| |
|||
|[[acyclovir]] |
|||
| |
|||
|above IC |
|||
| |
|||
|- |
|||
| |
|||
|[[valacyclovir]] |
|||
| |
|||
|20 to 30%, above IC in non-inflamed human eyes |
|||
|[[CiteRef::huynh2008vi]] |
|||
|- |
|||
| |
|||
|[[ganciclovir]] |
|||
| |
|||
|close to IC |
|||
| |
|||
|- |
|||
| |
|||
|[[foscarnet]] |
|||
|100% |
|||
|10%, close to IC |
|||
|[[CiteRef::lópez-cortés2000in]] |
|||
|} |
|||
[[Category:Antimicrobials]] |
[[Category:Antimicrobials]] |
Latest revision as of 17:51, 19 September 2024
Summary
- † if inflammation present
- ‡ very low levels, but likely enough for Enterococcus
Specific Tissues
Central Nervous System
- Reviewed in 3
Class | Antimicrobial | CSF Penetration (AUC) | With Meningeal Inflammation |
---|---|---|---|
Antibiotics | |||
penicillins | overall | 2% | 2% |
ampicillin | |||
amoxicillin | 6% | ||
cloxacillin | 0.87% | ||
piperacillin | 3% | 32% | |
beta lactamase inhibitors | overall | 7% | 10% |
clavulanate | 4% | 8% | |
tazobactam | 11% | ||
cephalosporins | overall | 0.7 to 10% | 15% |
cefotaxime | 12% | 4 to 17% | |
ceftriaxone | 0.7% | ||
ceftazidime | 0.6% | ||
carbapenems | overall | 20% | 30% |
imipenem | 14% | ||
meropenem | 5 to 25% | 39% | |
aminoglycosides | overall | 20% | |
fluoroquinolones | overall | 30 to 70% | 70 to 90% |
ciprofloxacin | 24 to 43% | 92% | |
levofloxacin | 71% | ||
moxifloxacin | 46% | 79% | |
chloramphenicol | 60 to 70% | 60 to 70% | |
macrolides | clarithromycin | 18% | |
tetracyclines | doxycycline | 20% | 20% |
fosfomycin | 18% | ||
linezolid | 90% | ||
metronidazole | 87% | ||
rifamycins | rifampin | 22% | |
trimethoprim-sulfamethoxazole | trimethoprim | 18% | 42 to 51% |
sulfamethoxazole | 12% | 24 to 30% | |
glycopeptides | vancomycin | 14 to 18% | 30% |
antituberculosis medications | isoniazid | 86% | |
Antivirls | |||
anti-herpes nucleoside analogues | acyclovir | 31% | |
valacyclovir | 19% | ||
foscarnet | 27 to 43% | 23 to 66% | |
HIV antiretrovirals | abacavir | 35% | |
zidovudine | 75% | ||
indinavir | 6 to 15% | ||
lopinavir | 29% | ||
Antifungals | |||
flucytosine | 74% | ||
azoles | fluconazole | 86% | |
voriconazole | 46% | ||
polyenes | amphotericin B | low | |
Antiparasitics | |||
albendazole | 38 to 43% | ||
praziquantel | 24% | ||
sulfadiazine | 27 to 33% |
Prostate
- Poorly penetrated by most antibiotics
- Penetration is higher with a high concentration gradient, high lipid solubility, low degree of ionization, high dissociation constant, low protein binding, and small molecular size
- Fluoroquinolones are the mainstay of therapy, though there is increasing resistance
- TMP-SMX often used, though conflicting data about its penetration into the prostate
- Minocycline, doxycycline, and macrolides achieve high levels in the prostate but are rarely indicated for the causative organisms
- Third-generation cephalosporins and carbapenems can be used
- Piperacillin, aztreonam, imipenem, and some aminoglycosides are likely useful
Bone
- Essentially all antibiotics achieve similar bone-to-serum levels, with the exception of oral β-lactams which nevertheless have no worse outcomes4
Eye
- Ocular compartments include anterior and posterior
- Anterior includes aqeous humour, and is best accessed using topical medications
- Posterior includes vitreous humour, retina, and choroid, and is best accessed using intravitreal or systemic medications
- Penetration of systemic antimicrobials into retina and vitreous is poor (~0 to 2%), but is better with inflammation5
- Preferred agents for vitreal penetration include meropenem, linezolid, and moxifloxacin
- Agents that are likely effective, especially when inflammation is present, include vancomycin, cefazolin, ceftriaxone, ceftazidime, imipenem, and trimethoprim-sulfamethoxazole, and possible daptomycin and rifampin
- Agents that do not reach adequate levels include ciprofloxacin, levofloxacin, aminoglycosides, aminopenicillins, piperacillin, cefepime, and clarithromycin
Class | Antimicrobial | Retinal Penetration | Vitreal Penetration | Ref |
---|---|---|---|---|
Antibiotics | ||||
penicillins | ampicillin | below MIC in non-inflamed rabbit eyes | 5 | |
amoxicillin | 2% (below MIC) in non-inflamed rabbit eyes | 5 | ||
piperacillin | undetectable in inflamed human eyes | 5 | ||
cephalosporins | cefazolin | above MIC in inflamed rabbit eyes | 5 | |
ceftriaxone | 4% in non-inflamed human eyes | 5 | ||
ceftazidime | 30% in inflamed rabbit eyes | 5 | ||
cefipime | 8% in non-inflamed human eyes | 5 | ||
carbapenems | imipenem | 8 to 10% in non-inflamed human eyes | 5 | |
meropenem | 30% in non-inflamed human eyes | 5 | ||
oxazolidinones | linezolid | 30 to 80% in non-inflamed human eyes | 5 | |
vancomycin | above MIC in inflamed rabbit eyes | 5 | ||
daptomycin | 30% in inflamed human eyes | 5 | ||
aminoglycosides | amikacin | below MIC in inflamed rabbit eyes | 5 | |
gentamicin | below MIC in inflamed rabbit eyes | 5 | ||
fluoroquinolones | ciprofloxacin | below MIC in non-inflamed human eyes | 5 | |
levofloxacin | 30% but below MIC in non-inflamed human eyes | 5 | ||
moxifloxacin | 10 to 40% and above MIC in non-inflamed human eyes | 5 | ||
Antifungals | ||||
azoles | fluconazole | 40 to 50% | 40 to 50% | 62 |
itraconazole | 10% in inflamed eyes | 2 | ||
posaconazole | 20% in inflamed eyes | 2 | ||
voriconazole | 40 to 100% | 2 | ||
flucytosine | 40 to 100% | 2 | ||
polyenes | liposomal amphotericin B | only detectable in inflamed eyes | 2 | |
echinocandins | echinocandins | very low penetration | 2 | |
micafungin | excellent | undetectable | 62 | |
Antivirals | ||||
acyclovir | above IC | |||
valacyclovir | 20 to 30%, above IC in non-inflamed human eyes | 7 | ||
ganciclovir | close to IC | |||
foscarnet | 100% | 10%, close to IC | 8 |
References
- ^ Tomasz Jodlowski, Charles R Ashby, Sarath G Nath. Doxycycline for ESBL-E Cystitis. Clinical Infectious Diseases. 2020. doi:10.1093/cid/ciaa1898.
- a b c d e f g h i Timothy Felton, Peter F. Troke, William W. Hope. Tissue Penetration of Antifungal Agents. Clinical Microbiology Reviews. 2014;27(1):68-88. doi:10.1128/cmr.00046-13.
- ^ nau2010pe
- ^ Cornelia B. Landersdorfer, Jürgen B. Bulitta, Martina Kinzig, Ulrike Holzgrabe, Fritz Sörgel. Penetration of Antibacterials into Bone. Clinical Pharmacokinetics. 2009;48(2):89-124. doi:10.2165/00003088-200948020-00002.
- a b c d e f g h i j k l m n o p q r L. Brockhaus, D. Goldblum, L. Eggenschwiler, S. Zimmerli, C. Marzolini. Revisiting systemic treatment of bacterial endophthalmitis: a review of intravitreal penetration of systemic antibiotics. Clinical Microbiology and Infection. 2019;25(11):1364-1369. doi:10.1016/j.cmi.2019.01.017.
- a b Takashi Suzuki, Toshihiko Uno, Guangming Chen, Yuichi Ohashi. Ocular distribution of intravenously administered micafungin in rabbits. Journal of Infection and Chemotherapy. 2008;14(3):204-207. doi:10.1007/s10156-008-0612-5.
- ^ Tony H. Huynh, Mark W. Johnson, Grant M. Comer, Douglas N. Fish. Vitreous Penetration of Orally Administered Valacyclovir. American Journal of Ophthalmology. 2008;145(4):682-686. doi:10.1016/j.ajo.2007.11.016.
- ^ Luis F. López-Cortés, R. Ruiz-Valderas, M. J. Lucero-Muñoz, E. Cordero, M. T. Pastor-Ramos, J. Marquez. Intravitreal, Retinal, and Central Nervous System Foscarnet Concentrations after Rapid Intravenous Administration to Rabbits. Antimicrobial Agents and Chemotherapy. 2000;44(3):756-759. doi:10.1128/aac.44.3.756-759.2000.