Tissue penetration of antimicrobials
From IDWiki
Summary
Class | Antimicrobial | Blood | CNS | 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 | – | + | |||
Macrolides | macrolides | – | + | |||
Nitrofurans | nitrofurantoin | – | – | + | – | – |
Nitroimidazoles | metronidazole | + | ||||
Rifamycins | rifampin | + | ||||
Sulfonamides | trimethoprim-sulfamethoxazole | + | ||||
Tetracyclines | tetracyclines | – | + | |||
doxycycline | + | + | ||||
Antifungals | ||||||
Azoles | fluconazole | + | ||||
Echinocandins | + | – | ||||
Class | Antimicrobial | Blood | CNS | Urine | Prostate | Necrotic |
- † 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
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.