Tissue penetration of antimicrobials: Difference between revisions
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*† if inflammation present |
*† if inflammation present |
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== Specific Tissues == |
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*Poorly penetrated by most antibiotics |
*Poorly penetrated by most antibiotics |
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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== |
===Bone=== |
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*Essentially all antibiotics achieve similar bone-to-serum levels, with the exception of oral β-lactams which nevertheless have no worse outcomes[[CiteRef::landersdorfer2009pe]] |
*Essentially all antibiotics achieve similar bone-to-serum levels, with the exception of oral β-lactams which nevertheless have no worse outcomes[[CiteRef::landersdorfer2009pe]] |
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=== Eye === |
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* Ocular compartments include anterior and posterior |
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** Anterior includes aqeous humour, and is best accessed using topical medications |
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** Posterior includes vitreous humour, retina, and choroid, and is best accessed using intravitreal or systemic medications |
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* Penetration of systemic antimicrobials into retina and vitreous is poor (~0 to 2%), but is better with inflammation[[CiteRef::brockhaus2019re]] |
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{| class="wikitable" |
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!Class |
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!Antimicrobial |
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!Vitreal Penetration |
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|- |
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| rowspan="3" |penicillins |
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|[[ampicillin]] |
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|below MIC in non-inflamed rabbit eyes |
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|- |
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|[[amoxicillin]] |
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|2% (below MIC) in non-inflamed rabbit eyes |
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|- |
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|[[piperacillin]] |
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|undetectable in inflamed human eyes |
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|- |
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| rowspan="4" |cephalosporins |
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|[[cefazolin]] |
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|above MIC in inflamed rabbit eyes |
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|- |
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|[[ceftriaxone]] |
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|4% in non-inflamed human eyes |
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|- |
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|[[ceftazidime]] |
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|30% in inflamed rabbit eyes |
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|- |
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|[[cefipime]] |
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|8% in non-inflamed human eyes |
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|- |
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| rowspan="2" |carbapenems |
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|[[imipenem]] |
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|8 to 10% in non-inflamed human eyes |
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|- |
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|[[meropenem]] |
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|30% in non-inflamed human eyes |
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|- |
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|oxazolidinones |
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|[[linezolid]] |
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|30 to 80% in non-inflamed human eyes |
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|- |
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| |
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|[[vancomycin]] |
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|above MIC in inflamed rabbit eyes |
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|- |
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| |
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|[[daptomycin]] |
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|30% in inflamed human eyes |
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|- |
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| rowspan="2" |aminoglycosides |
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|[[amikacin]] |
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|below MIC in inflamed rabbit eyes |
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|- |
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|[[gentamicin]] |
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|below MIC in inflamed rabbit eyes |
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|- |
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| rowspan="3" |fluoroquinolones |
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|[[ciprofloxacin]] |
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|below MIC in non-inflamed human eyes |
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|- |
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|[[levofloxacin]] |
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|30% but below MIC in non-inflamed human eyes |
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|- |
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|[[moxifloxacin]] |
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|10 to 40% and above MIC in non-inflamed human eyes |
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|} |
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[[Category:Antimicrobials]] |
[[Category:Antimicrobials]] |
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Revision as of 14:58, 6 March 2021
Summary
| Class | Antimicrobial | Blood | CNS | Vitreous | Urine | Prostate | Necrotic |
|---|---|---|---|---|---|---|---|
| Antibiotics: β-Lactams | |||||||
| Penicillins | β-lactamase inhibitors | – | |||||
| ampicillin | + | – | |||||
| piperacillin-tazobactam | +† | ||||||
| Cephalosporins | first-generation cephalosporins | – | – | ||||
| second-generation cephalosporins | – | ||||||
| third-generation cephalosporins | +† | ||||||
| cefepime | + | ||||||
| ceftazidime | + | + | |||||
| Cephamycins | cephamycins | – | |||||
| cefoxitin | – | ||||||
| Carbapenems | imipenem | + | |||||
| Antibiotics: Non-β-Lactams | |||||||
| Aminoglycosides | – | ||||||
| Chloramphenicol | chloramphenicol | + | |||||
| Fluoroquinolones | –? | + | + | ||||
| Fosfomycin | fosfomycin | + | |||||
| Lincosamides | clindamycin | – | + | ||||
| Lipopeptides | daptomycin | + | – | + | |||
| Macrolides | macrolides | – | + | ||||
| Nitrofurans | nitrofurantoin | – | – | + | – | – | |
| Nitroimidazoles | metronidazole | + | |||||
| Rifamycins | rifampin | + | |||||
| Sulfonamides | trimethoprim-sulfamethoxazole | + | |||||
| Tetracyclines | tetracyclines | – | + | ||||
| doxycycline | + | + | |||||
| Antivirals | |||||||
| acyclovir / valacyclovir | + | ||||||
| ganciclovir | + | ||||||
| foscarnet | |||||||
| Antifungals | |||||||
| Azoles | fluconazole | + | |||||
| Echinocandins | + | – | |||||
| Class | Antimicrobial | Blood | CNS | Urine | Prostate | Necrotic | |
- † if inflammation present
Specific Tissues
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 outcomes1
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 inflammation2
| Class | Antimicrobial | Vitreal Penetration |
|---|---|---|
| penicillins | ampicillin | below MIC in non-inflamed rabbit eyes |
| amoxicillin | 2% (below MIC) in non-inflamed rabbit eyes | |
| piperacillin | undetectable in inflamed human eyes | |
| cephalosporins | cefazolin | above MIC in inflamed rabbit eyes |
| ceftriaxone | 4% in non-inflamed human eyes | |
| ceftazidime | 30% in inflamed rabbit eyes | |
| cefipime | 8% in non-inflamed human eyes | |
| carbapenems | imipenem | 8 to 10% in non-inflamed human eyes |
| meropenem | 30% in non-inflamed human eyes | |
| oxazolidinones | linezolid | 30 to 80% in non-inflamed human eyes |
| vancomycin | above MIC in inflamed rabbit eyes | |
| daptomycin | 30% in inflamed human eyes | |
| aminoglycosides | amikacin | below MIC in inflamed rabbit eyes |
| gentamicin | below MIC in inflamed rabbit eyes | |
| fluoroquinolones | ciprofloxacin | below MIC in non-inflamed human eyes |
| levofloxacin | 30% but below MIC in non-inflamed human eyes | |
| moxifloxacin | 10 to 40% and above MIC in non-inflamed human eyes |
References
- ^ 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.
- ^ 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.
