Tissue penetration of antimicrobials: Difference between revisions
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*† if inflammation present |
*† if inflammation present |
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+ | ==Prostate== |
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+ | *Poorly penetrated by most antibiotics |
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+ | *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 |
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+ | *[[Fluoroquinolones]] are the mainstay of therapy, though there is increasing resistance |
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+ | *[[TMP-SMX]] often used, though conflicting data about its penetration into the prostate |
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+ | *[[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 |
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+ | *[[Piperacillin]], [[aztreonam]], [[imipenem]], and some [[aminoglycosides]] are likely useful |
[[Category:Antimicrobials]] |
[[Category:Antimicrobials]] |
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Revision as of 14:44, 16 September 2020
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 | + | ||||
| 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
- ^ 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.
- 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.
- ^ 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.
