Tissue penetration of antimicrobials: Difference between revisions
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+ | | style="text-align:center" |Β± |
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β | | |
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|[[piperacillin-tazobactam]] |
|[[piperacillin-tazobactam]] |
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β | | style="text-align:center" | |
+ | | style="text-align:center" |β |
+ | | style="text-align:center" |β |
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β | | |
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| style="text-align:center" | +β |
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|- |
|- |
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β | | rowspan=" |
+ | | rowspan="6" |[[Cephalosporins]] |
|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" |β |
| style="text-align:center" |β |
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+ | | style="text-align:center" |β |
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β | | |
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| style="text-align:center" |β |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" |Β± |
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β | | |
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| style="text-align:center" | +β |
| style="text-align:center" | +β |
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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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β | | |
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| style="text-align:center" | + |
| style="text-align:center" | + |
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+ | | style="text-align:center" |Β± |
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β | | |
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| style="text-align:center" |β |
| style="text-align:center" |β |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" | |
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β | | |
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| style="text-align:center" | |
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| style="text-align:center" |β |
| style="text-align:center" |β |
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|- |
|- |
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β | |[[Carbapenems]] |
+ | | rowspan="2" |[[Carbapenems]] |
|[[imipenem]] |
|[[imipenem]] |
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| style="text-align:center" | |
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+ | | style="text-align:center" | |
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β | | |
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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" | |
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β | | |
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+ | | style="text-align:center" | |
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β | | |
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| style="text-align:center" | |
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| style="text-align:center" | + |
| style="text-align:center" | + |
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|- |
|- |
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β | |[[Fluoroquinolones]] |
+ | | rowspan="2" |[[Fluoroquinolones]] |
+ | |all |
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+ | | style="text-align:center" |β? |
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β | | style="text-align:center" |β? |
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β | | |
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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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+ | |- |
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+ | |[[moxifloxacin]] |
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+ | | |
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+ | | |
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+ | | |
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+ | |β |
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+ | | |
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+ | | |
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|- |
|- |
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|[[Fosfomycin]] |
|[[Fosfomycin]] |
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+ | | style="text-align:center" | |
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β | | |
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| style="text-align:center" | + |
| style="text-align:center" | + |
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| style="text-align:center" |β |
| style="text-align:center" |β |
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+ | | style="text-align:center" | |
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β | | |
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|[[Lipopeptides]] |
|[[Lipopeptides]] |
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|[[daptomycin]] |
|[[daptomycin]] |
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+ | | style="text-align:center" | + |
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β | | + |
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+ | | style="text-align:center" |β |
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β | |β |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" | + |
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β | | + |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" | |
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β | | |
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|- |
|- |
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|[[Macrolides]] |
|[[Macrolides]] |
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| style="text-align:center" | |
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| style="text-align:center" |β |
| style="text-align:center" |β |
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+ | | style="text-align:center" | |
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β | | |
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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" |β |
| style="text-align:center" |β |
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| style="text-align:center" |β |
| style="text-align:center" |β |
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+ | | style="text-align:center" |β |
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β | | |
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| style="text-align:center" | + |
| style="text-align:center" | + |
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| style="text-align:center" |β |
| style="text-align:center" |β |
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+ | | style="text-align:center" | |
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β | | |
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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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+ | |[[Oxazolidinones]] |
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+ | |[[linezolid]] |
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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" |Β±β‘ |
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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]] |
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+ | | style="text-align:center" | |
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β | | |
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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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β | | |
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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" |β |
| style="text-align:center" |β |
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+ | | style="text-align:center" | |
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β | | |
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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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β | | |
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| style="text-align:center" | |
| style="text-align:center" | |
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+ | | style="text-align:center" |Β±<ref>Tomasz Jodlowski, Charles R Ashby, Sarath G Nath, Doxycycline for ESBL-E Cystitis, ''Clinical Infectious Diseases'', Volume 73, Issue 1, 1 July 2021, Pages e274βe275, https://doi.org/10.1093/cid/ciaa1898</ref> |
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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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|[[acyclovir]] / [[valacyclovir]] |
|[[acyclovir]] / [[valacyclovir]] |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" | + |
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β | | + |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" | |
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β | | |
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|- |
|- |
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| |
| |
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|[[ganciclovir]] |
|[[ganciclovir]] |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" | + |
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β | | + |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" | |
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β | | |
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|- |
|- |
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| |
| |
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|[[foscarnet]] |
|[[foscarnet]] |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" | |
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β | | |
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+ | | style="text-align:center" | |
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β | | |
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|- |
|- |
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+ | ! colspan="8" |Antifungals<ref>Felton T, Troke PF, Hope WW. Tissue penetration of antifungal agents. Clin Microbiol Rev. 2014 Jan;27(1):68-88. doi: 10.1128/CMR.00046-13. PMID: 24396137; PMCID: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3910906/ PMC3910906].</ref> |
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β | ! colspan="8" |Antifungals |
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|- |
|- |
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β | |[[Azoles]] |
+ | | rowspan="3" |[[Azoles]] |
|[[fluconazole]] |
|[[fluconazole]] |
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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" |Β± |
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+ | | style="text-align:center" | + |
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+ | |- |
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+ | |[[itraconazole]] |
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| style="text-align:center" | |
| style="text-align:center" | |
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+ | | style="text-align:center" |Β± |
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β | | |
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+ | | style="text-align:center" |β |
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+ | | style="text-align:center" | + |
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+ | | style="text-align:center" |β |
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| style="text-align:center" | |
| style="text-align:center" | |
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+ | |- |
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+ | |[[voriconazole]] |
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| style="text-align:center" | |
| style="text-align:center" | |
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+ | | style="text-align:center" |Β± |
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+ | | style="text-align:center" |Β± |
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+ | | style="text-align:center" |Β± |
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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]] |
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| style="text-align:center" | + |
| style="text-align:center" | + |
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+ | | style="text-align:center" |Β± |
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+ | | style="text-align:center" |β |
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+ | | style="text-align:center" |Β± |
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+ | | style="text-align:center" | |
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+ | | style="text-align:center" | |
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|- |
|- |
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β | |[[ |
+ | |[[caspofungin]] |
+ | | style="text-align:center" | + |
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+ | | style="text-align:center" |β |
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+ | | style="text-align:center" |β |
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+ | | style="text-align:center" |Β± |
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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]] |
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+ | | style="text-align:center" | |
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+ | | style="text-align:center" |Β± |
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+ | | style="text-align:center" |β |
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+ | | style="text-align:center" |Β± |
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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" | |
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+ | | style="text-align:center" | |
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+ | | style="text-align:center" |β |
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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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β | | |
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+ | |- |
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+ | |liposomal [[amphotericin B]] |
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+ | | style="text-align:center" | |
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| style="text-align:center" |β |
| style="text-align:center" |β |
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+ | | style="text-align:center" |Β±β |
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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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!Blood |
!Blood |
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!CNS |
!CNS |
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+ | !Vitreous |
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β | ! |
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!Urine |
!Urine |
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!Prostate |
!Prostate |
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*β if inflammation present |
*β if inflammation present |
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+ | *β‘ very low levels, but likely enough for [[Enterococcus]] |
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==Specific Tissues== |
==Specific Tissues== |
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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]] |
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+ | |overall |
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+ | |2% |
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+ | |2% |
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+ | |- |
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+ | |[[ampicillin]] |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[amoxicillin]] |
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+ | | |
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+ | |6% |
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+ | |- |
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+ | |[[cloxacillin]] |
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+ | |0.87% |
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+ | | |
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+ | |- |
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+ | |[[piperacillin]] |
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+ | |3% |
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+ | |32% |
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+ | |- |
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+ | | rowspan="3" |beta lactamase inhibitors |
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+ | |overall |
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+ | |7% |
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+ | |10% |
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+ | |- |
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+ | |[[clavulanate]] |
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+ | |4% |
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+ | |8% |
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+ | |- |
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+ | |[[tazobactam]] |
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+ | |11% |
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+ | | |
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+ | |- |
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+ | | rowspan="4" |[[cephalosporins]] |
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+ | |overall |
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+ | |0.7 to 10% |
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+ | |15% |
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+ | |- |
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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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+ | | |
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+ | |- |
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+ | |[[ceftazidime]] |
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+ | |0.6% |
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+ | | |
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+ | |- |
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+ | | rowspan="3" |[[carbapenems]] |
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+ | |overall |
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+ | |20% |
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+ | |30% |
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+ | |- |
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+ | |imipenem |
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+ | | |
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+ | |14% |
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+ | |- |
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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 |
||
+ | |20% |
||
+ | | |
||
+ | |- |
||
+ | | rowspan="4" |[[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% |
||
+ | |- |
||
+ | ! 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=== |
===Prostate=== |
||
Line 312: | Line 619: | ||
!Class |
!Class |
||
!Antimicrobial |
!Antimicrobial |
||
+ | !Retinal Penetration |
||
!Vitreal Penetration |
!Vitreal Penetration |
||
+ | !Ref |
||
|- |
|- |
||
β | + | ! colspan="5" |Antibiotics |
|
+ | |- |
||
+ | | rowspan="3" |[[penicillins]] |
||
|[[ampicillin]] |
|[[ampicillin]] |
||
+ | | |
||
|below MIC in non-inflamed rabbit eyes |
|below MIC in non-inflamed rabbit eyes |
||
+ | |[[CiteRef::brockhaus2019re]] |
||
|- |
|- |
||
|[[amoxicillin]] |
|[[amoxicillin]] |
||
+ | | |
||
|2% (below MIC) in non-inflamed rabbit eyes |
|2% (below MIC) in non-inflamed rabbit eyes |
||
+ | |[[CiteRef::brockhaus2019re]] |
||
|- |
|- |
||
|[[piperacillin]] |
|[[piperacillin]] |
||
+ | | |
||
|undetectable in inflamed human eyes |
|undetectable in inflamed human eyes |
||
+ | |[[CiteRef::brockhaus2019re]] |
||
|- |
|- |
||
β | | rowspan="4" |cephalosporins |
+ | | rowspan="4" |[[cephalosporins]] |
|[[cefazolin]] |
|[[cefazolin]] |
||
+ | | |
||
|above MIC in inflamed rabbit eyes |
|above MIC in inflamed rabbit eyes |
||
+ | |[[CiteRef::brockhaus2019re]] |
||
|- |
|- |
||
|[[ceftriaxone]] |
|[[ceftriaxone]] |
||
+ | | |
||
|4% in non-inflamed human eyes |
|4% in non-inflamed human eyes |
||
+ | |[[CiteRef::brockhaus2019re]] |
||
|- |
|- |
||
|[[ceftazidime]] |
|[[ceftazidime]] |
||
+ | | |
||
|30% in inflamed rabbit eyes |
|30% in inflamed rabbit eyes |
||
+ | |[[CiteRef::brockhaus2019re]] |
||
|- |
|- |
||
|[[cefipime]] |
|[[cefipime]] |
||
+ | | |
||
|8% in non-inflamed human eyes |
|8% in non-inflamed human eyes |
||
+ | |[[CiteRef::brockhaus2019re]] |
||
|- |
|- |
||
β | | rowspan="2" |carbapenems |
+ | | rowspan="2" |[[carbapenems]] |
|[[imipenem]] |
|[[imipenem]] |
||
+ | | |
||
|8 to 10% in non-inflamed human eyes |
|8 to 10% in non-inflamed human eyes |
||
+ | |[[CiteRef::brockhaus2019re]] |
||
|- |
|- |
||
|[[meropenem]] |
|[[meropenem]] |
||
+ | | |
||
|30% in non-inflamed human eyes |
|30% in non-inflamed human eyes |
||
+ | |[[CiteRef::brockhaus2019re]] |
||
|- |
|- |
||
β | |oxazolidinones |
+ | |[[oxazolidinones]] |
|[[linezolid]] |
|[[linezolid]] |
||
+ | | |
||
|30 to 80% in non-inflamed human eyes |
|30 to 80% in non-inflamed human eyes |
||
+ | |[[CiteRef::brockhaus2019re]] |
||
|- |
|- |
||
| |
| |
||
|[[vancomycin]] |
|[[vancomycin]] |
||
+ | | |
||
|above MIC in inflamed rabbit eyes |
|above MIC in inflamed rabbit eyes |
||
+ | |[[CiteRef::brockhaus2019re]] |
||
|- |
|- |
||
| |
| |
||
|[[daptomycin]] |
|[[daptomycin]] |
||
+ | | |
||
|30% in inflamed human eyes |
|30% in inflamed human eyes |
||
+ | |[[CiteRef::brockhaus2019re]] |
||
|- |
|- |
||
β | | rowspan="2" |aminoglycosides |
+ | | rowspan="2" |[[aminoglycosides]] |
|[[amikacin]] |
|[[amikacin]] |
||
+ | | |
||
|below MIC in inflamed rabbit eyes |
|below MIC in inflamed rabbit eyes |
||
+ | |[[CiteRef::brockhaus2019re]] |
||
|- |
|- |
||
|[[gentamicin]] |
|[[gentamicin]] |
||
+ | | |
||
|below MIC in inflamed rabbit eyes |
|below MIC in inflamed rabbit eyes |
||
+ | |[[CiteRef::brockhaus2019re]] |
||
|- |
|- |
||
β | | rowspan="3" |fluoroquinolones |
+ | | rowspan="3" |[[fluoroquinolones]] |
|[[ciprofloxacin]] |
|[[ciprofloxacin]] |
||
+ | | |
||
|below MIC in non-inflamed human eyes |
|below MIC in non-inflamed human eyes |
||
+ | |[[CiteRef::brockhaus2019re]] |
||
|- |
|- |
||
|[[levofloxacin]] |
|[[levofloxacin]] |
||
+ | | |
||
|30% but below MIC in non-inflamed human eyes |
|30% but below MIC in non-inflamed human eyes |
||
+ | |[[CiteRef::brockhaus2019re]] |
||
|- |
|- |
||
|[[moxifloxacin]] |
|[[moxifloxacin]] |
||
+ | | |
||
|10 to 40% and above MIC in non-inflamed human eyes |
|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::lΓ³pez-cortΓ©s2000in]] |
||
|} |
|} |
||
[[Category:Antimicrobials]] |
[[Category:Antimicrobials]] |
Latest revision as of 10:55, 1 November 2023
Summary
Class | Antimicrobial | Blood | CNS | Vitreous | Urine | Prostate | Necrotic |
---|---|---|---|---|---|---|---|
Antibiotics: Ξ²-Lactams | |||||||
Penicillins | Ξ²-lactamase inhibitors | β | |||||
ampicillin | + | Β± | β | ||||
piperacillin-tazobactam | β | β | +β | ||||
Cephalosporins | first-generation cephalosporins | β | β | β | |||
second-generation cephalosporins | β | ||||||
third-generation cephalosporins | Β± | +β | |||||
ceftriaxone | + | ||||||
cefepime | + | ||||||
ceftazidime | + | Β± | + | ||||
Cephamycins | cephamycins | β | |||||
cefoxitin | β | ||||||
Carbapenems | imipenem | + | |||||
meropenem | + | + | + | ||||
Antibiotics: Non-Ξ²-Lactams | |||||||
Aminoglycosides | β | ||||||
Chloramphenicol | chloramphenicol | + | |||||
Fluoroquinolones | all | β? | + | + | |||
moxifloxacin | β | ||||||
Fosfomycin | fosfomycin | + | |||||
Lincosamides | clindamycin | β | + | ||||
Lipopeptides | daptomycin | + | β | + | |||
Macrolides | macrolides | β | + | ||||
Nitrofurans | nitrofurantoin | β | β | β | + | β | β |
Nitroimidazoles | metronidazole | + | |||||
Oxazolidinones | linezolid | + | + | + | Β±β‘ | ||
Rifamycins | rifampin | + | |||||
Sulfonamides | trimethoprim-sulfamethoxazole | + | |||||
Tetracyclines | tetracyclines | β | + | ||||
doxycycline | Β±[1] | + | + | ||||
Antivirals | |||||||
acyclovir / valacyclovir | + | ||||||
ganciclovir | + | ||||||
foscarnet | |||||||
Antifungals[2] | |||||||
Azoles | fluconazole | + | + | + | Β± | + | |
itraconazole | Β± | β | + | β | |||
voriconazole | Β± | Β± | Β± | ||||
Echinocandins | anidulafungin | + | Β± | β | Β± | ||
caspofungin | + | β | β | Β± | |||
micafungin | Β± | β | Β± | ||||
Polyenes | deoxycholate amphotericin B | β | + | ||||
liposomal amphotericin B | β | Β±β | + | ||||
Class | Antimicrobial | Blood | CNS | Vitreous | Urine | Prostate | Necrotic |
- β if inflammation present
- β‘ very low levels, but likely enough for Enterococcus
Specific Tissues
Central Nervous System
- Reviewed in 1
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 Ξ²-lactams which nevertheless have no worse outcomes2
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 inflammation3
- 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 | 3 | |
amoxicillin | 2% (below MIC) in non-inflamed rabbit eyes | 3 | ||
piperacillin | undetectable in inflamed human eyes | 3 | ||
cephalosporins | cefazolin | above MIC in inflamed rabbit eyes | 3 | |
ceftriaxone | 4% in non-inflamed human eyes | 3 | ||
ceftazidime | 30% in inflamed rabbit eyes | 3 | ||
cefipime | 8% in non-inflamed human eyes | 3 | ||
carbapenems | imipenem | 8 to 10% in non-inflamed human eyes | 3 | |
meropenem | 30% in non-inflamed human eyes | 3 | ||
oxazolidinones | linezolid | 30 to 80% in non-inflamed human eyes | 3 | |
vancomycin | above MIC in inflamed rabbit eyes | 3 | ||
daptomycin | 30% in inflamed human eyes | 3 | ||
aminoglycosides | amikacin | below MIC in inflamed rabbit eyes | 3 | |
gentamicin | below MIC in inflamed rabbit eyes | 3 | ||
fluoroquinolones | ciprofloxacin | below MIC in non-inflamed human eyes | 3 | |
levofloxacin | 30% but below MIC in non-inflamed human eyes | 3 | ||
moxifloxacin | 10 to 40% and above MIC in non-inflamed human eyes | 3 | ||
Antifungals | ||||
azoles | fluconazole | 40 to 50% | 40 to 50% | 45 |
itraconazole | 10% in inflamed eyes | 5 | ||
posaconazole | 20% in inflamed eyes | 5 | ||
voriconazole | 40 to 100% | 5 | ||
flucytosine | 40 to 100% | 5 | ||
polyenes | liposomal amphotericin B | only detectable in inflamed eyes | 5 | |
echinocandins | echinocandins | very low penetration | 5 | |
micafungin | excellent | undetectable | 45 | |
Antivirals | ||||
acyclovir | above IC | |||
valacyclovir | 20 to 30%, above IC in non-inflamed human eyes | 6 | ||
ganciclovir | close to IC | |||
foscarnet | 100% | 10%, close to IC | 7 |
- β Tomasz Jodlowski, Charles R Ashby, Sarath G Nath, Doxycycline for ESBL-E Cystitis, Clinical Infectious Diseases, Volume 73, Issue 1, 1 July 2021, Pages e274βe275, https://doi.org/10.1093/cid/ciaa1898
- β Felton T, Troke PF, Hope WW. Tissue penetration of antifungal agents. Clin Microbiol Rev. 2014 Jan;27(1):68-88. doi: 10.1128/CMR.00046-13. PMID: 24396137; PMCID: PMC3910906.
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.
- 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.
- a b c d e f g h T. Felton, P. F. Troke, W. W. Hope. Tissue Penetration of Antifungal Agents. Clinical Microbiology Reviews. 2014;27(1):68-88. doi:10.1128/cmr.00046-13.