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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+ | |||
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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=== |
*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]] |
Revision as of 10:58, 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.