Penetration of Antitubercular Drugs in Clinical Osteoarticular Tubercular Lesions

Tuli, SM; Kumar, Kush; Sen, P. C.

doi:10.3109/17453677708992009

Cited by 36 publications

(19 citation statements)

References 7 publications

(9 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is, however, very little information available on the reassessment of drug concentration at the site of lesions after a period of chemotherapy [6]. It has been presumed that the concentration is likely to diminish as healing occurs by fibrosis.…”

Section: Introductionmentioning

confidence: 99%

The penetration of drugs into the lesions of spinal tuberculosis

Kumar

1992

International Orthopaedics

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

The penetration of drugs into the lesions of spinal tuberculosis

Kumar

1992

International Orthopaedics

View full text Add to dashboard Cite

show abstract

“…Anti-tubercular drugs reach at the site of osteoarticular tubercular lesion in adequate concentration when administered in therapeutic doses [24][25][26][27]. Posterior spinal tuberculosis is no exception.…”

Section: Discussionmentioning

confidence: 99%

Posterior Spinal Tuberculosis: A Review

Kumar¹

2017

Mycobact Dis

Self Cite

View full text Add to dashboard Cite

Natural history of posterior spinal tuberculosis has been described. Classifications of the posterior spinal tuberculosis disease process and principles of management based upon the clinical behavior of the disease has been highlighted and emphasized. A thorough review of literature was conducted with the aim to provide the clinicoradiological correlation of the natural history of posterior spinal tuberculosis in described. Management strategy is developed based upon the severity of the clinical behavior of the disease. In anterior spinal tuberculosis, motor fibers are compressed first as they are placed anterior to the sensory tracts in the spinal cord. The sensory fibers are therefore involved in late stages. Ironically, in posterior spinal tuberculosis when compression is predominantly from the posterior aspect of the cord, we again find that motor fibers are involved prior to the sensory fibers. This is in contradiction to the general belief. It is difficult to offer any simple explanation to this apparent paradox. In general, motor fibers are considered more susceptible to pressure effect, whereas sensory fibers are more susceptible to ischemia.That is why in compression paraplegia, signs and symptoms of motor loss appear prior to the sensory loss, as collaterals prevent ischemia for quite some times. In posterior spinal tuberculosis when compression is from the posterior aspect of the cord, at first pressure is exerted on the column of cerebrospinal fluid (CSF) surrounding the cord and gets transmitted to the ligamentum denticulatum. Motor fibers in the close vicinity, get pulled and show early involvement. Secondly, in compression from the posterior aspect of the cord, the cord is displaced anteriorly and anteriorly placed motor fibers are compressed against the anterior wall of the bony spinal canal causing early motor fiber functional loss. Therefore similar classification of paraplegia predominantly based upon the progressive motor weakness is valid for paraplegia noted following posterior spinal tuberculosis. Neurological deficit grading based management is developed. Grade 1 and 2, conservative treatment, grade 3, gray zone and grade 4, operative treatment is emphasized. The five stages of natural history of tuberculosis of spine have been developed from the clinician's point of view. However, indications of surgery are different than what are described for the anterior spinal tuberculosis. Principles of management with role of rest, braces, chemotherapy and surgery are discussed. Management of posterior spinal tuberculosis of spine, in general, it is no different than management of soft tissue tuberculosis, in HIV negative or positive patients. Role of surgery is very different than anterior spinal tubercolosis. Management of posterior spinal tubercular paraplegia, is simple, logical, efficient and easy to understand and remember by any orthopedic/treating surgeon.

show abstract

“…The ratio of the aztreonam concentration in synovial fluid to that in serum compares favorably with that of streptomycin (50 to 75%) (30), trimethoprim-sulfamethoxazole (100%) (31), cefadroxil (43%) (23), cephalothin (20 to 53%) (9,26), cefamandole (28.1%) (26), gentamicin (88%) (6), and tobramycin (95%) (6). Aztreonam concentrations in cancellous bone (mean, 20% of that in concomitant serum) are similar to those of moxalactam (18%) (21), cefazolin (18%) (21), cefadroxil (23%) (23), cephalothin (5 to 33%) (7,9,26), cefamandole (5 to 20%) (18,24,26), cefuroxime (10 to 70%) (7), clindamycin (10 to 50%) (1,28), ceftazidime (54%) (1), and amoxicillin (16.4%) (2).…”

mentioning

confidence: 95%

Aztreonam penetration into synovial fluid and bone

MacLeod¹,

Bartley²,

Jo³

et al. 1986

Antimicrob Agents Chemother

View full text Add to dashboard Cite

Eighteen patients with uncomplicated degenerative joint disease requiring joint replacement (hip or knee) were given a single 2-g intravenous dose of aztreonam over a 5-min period preoperatively. The mean concentration in synovial fluid of 83.0 9.2 >g/ml averaged 0.99 times the concomitant levels in serum. The mean concentration in cancellous bone of 16.0 4.3 Lg/g averaged 0.20 times the concomitant levels in serum.The increasing incidence of gram-negative bone and joint infections (14,19), particularly in patients with underlying diseases (13), combined with a higher incidence of poor therapeutic outcome in patients with such infections treated with available antimicrobial agents (10,29) (17), except that the samples were pulverized with a Spex freezer-mill prior to assay. The limit of detection of the assay was 0.1 ,ug/g of bone. The coefficient of variation and mean recovery from standards were 8.0 and 79.0%, respectively.Bone samples were prepared for high-pressure liquid chromatography by a procedure identical to that used for the bioassay and then filtered (Millex; 0.45 pum [pore size]; Millipore Corp., Bedford, Mass.). They were then analyzed with a high-pressure liquid chromatography system consisting of an Altex model 11OA pump set for 2 ml/min, a 37-to 50-,um silica gel precolumn, a 30-to 38-,um C18 guard column, a Waters Associates, Inc., 10-,um ,Bondpak analytical column (150 by 3.9 mm), and a UV detector set for 290 nm. The mobile phase was 85 parts 5 mM tetrabutylammonium sulfate, adjusted to pH 2.85 with 1 M KH2PO4, and 15 parts acetonitrile. Samples were introduced via a 20-,u precision loop injector. The limit of detection was 1 ,ug/g, the coefficient of variation was 8.1%, and the mean recovery from standards was 87.0%.The method used for microbiological assay of synovial fluid was identical to that previously reported for urine (20), except that samples were diluted 1:20 in 0.1 M phosphate buffer (pH 6) prior to assay. The limit of detection was 0.4 ,g/ml. The coefficient of variation and mean recovery were 3.5 and 98%, respectively. The high-pressure liquid chromatographic assay of synovial fluid was done by a method identical to that previously reported for serum (20). The limit of detection was 0.5 ,ug/ml. The coefficient of variation and recovery from standards were 8.5 and 98%, respectively.Assays of hemoglobin in blood, bone, and synovial fluid and correction of aztreonam concentrations for blood contamination were performed by previously described methods (17). Samples whose blood contents were 51% or more were excluded from analysis. No specimens suitable for assay could be obtained from patient 6.Results of the aztreonam assays are listed in Table 1. The mean concentration in serum at the time of bone and synovial fluid removal was 78 ,ug/ml. The mean concentration in bone was 16 ,ug/g. Concentrations of aztreonam in individual bone specimens were variable but showed a 710

show abstract

Penetration of Antitubercular Drugs in Clinical Osteoarticular Tubercular Lesions

Cited by 36 publications

References 7 publications

The penetration of drugs into the lesions of spinal tuberculosis

The penetration of drugs into the lesions of spinal tuberculosis

Posterior Spinal Tuberculosis: A Review

Aztreonam penetration into synovial fluid and bone

Contact Info

Product

Resources

About