Tissue penetration of antimicrobials: Difference between revisions
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*Third-generation [[cephalosporins]] and [[carbapenems]] can be used |
*Third-generation [[cephalosporins]] and [[carbapenems]] can be used |
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*[[Piperacillin]], [[aztreonam]], [[imipenem]], and some [[aminoglycosides]] are likely useful |
*[[Piperacillin]], [[aztreonam]], [[imipenem]], and some [[aminoglycosides]] are likely useful |
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+ | == Bone == |
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+ | * Essentially all antibiotics achieve similar bone-to-serum levels, with the exception of oral Ξ²-lactams which nevertheless have no worse outcomes[[CiteRef::landersdorfer2009pe]] |
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[[Category:Antimicrobials]] |
[[Category:Antimicrobials]] |
Revision as of 14:41, 18 September 2020
Summary
Class | Antimicrobial | Blood | CNS | Urine | Prostate | Necrotic |
---|---|---|---|---|---|---|
Antibiotics: Ξ²-Lactams | ||||||
Penicillins | Ξ²-lactamase inhibitors | β | ||||
ampicillin | + | β | ||||
piperacillin-tazobactam | +β | |||||
Cephalosporins | first-generation cephalosporins | β | β | |||
second-generation cephalosporins | β | |||||
third-generation cephalosporins | +β | |||||
cefepime | + | |||||
ceftazidime | + | + | ||||
Cephamycins | cephamycins | β | ||||
cefoxitin | β | |||||
Carbapenems | imipenem | + | ||||
Antibiotics: Non-Ξ²-Lactams | ||||||
Aminoglycosides | β | |||||
Chloramphenicol | chloramphenicol | + | ||||
Fluoroquinolones | β? | + | + | |||
Fosfomycin | fosfomycin | + | ||||
Lincosamides | clindamycin | β | + | |||
Macrolides | macrolides | β | + | |||
Nitrofurans | nitrofurantoin | β | β | + | β | β |
Nitroimidazoles | metronidazole | + | ||||
Rifamycins | rifampin | + | ||||
Sulfonamides | trimethoprim-sulfamethoxazole | + | ||||
Tetracyclines | tetracyclines | β | + | |||
doxycycline | + | + | ||||
Antifungals | ||||||
Azoles | fluconazole | + | ||||
Echinocandins | + | β | ||||
Class | Antimicrobial | Blood | CNS | Urine | Prostate | Necrotic |
- β if inflammation present
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 Ξ²-lactams which nevertheless have no worse outcomes1
References
- ^ Cornelia B. Landersdorfer, JΓΌrgen B. Bulitta, Martina Kinzig, Ulrike Holzgrabe, Fritz SΓΆrgel. Penetration of Antibacterials into Bone. Clinical Pharmacokinetics. 2009;48(2):89-124. doi:10.2165/00003088-200948020-00002.