The Penetration of Penicillin and Other Antimicrobials into Joint Fluid

Septic arthritis.

“…The use of local antibiotics is still controversial, but there is no evidence from our series or those of other authors that this practice has any effect in preventing recurrences. All previous studies indicate that antibiotics pass very freely into synovial fluid from the blood stream easily achieving therapeutic levels (Rapp, Griffith, and Hebble, 1966;Drutz, Schaffner, Hillman, and Koenig, 1967;Gump and Lipson, 1968;Nelson, 1971;Parker and Schmid, 1971) and there would seem now to be no good reason for continuing this practice.…”

Management of bone and joint infections due to Staphylococcus aureus

“…Intravenous β-lactam agents have been demonstrated to achieve excellent levels in synovial fluid, as have lincosamides such as clindamycin, and the fluoroquinolones. 9,11,12,79 These levels are generally significantly above the MIC of methicillin-sensitive S. aureus. The practice of injecting antibiotics directly into infected joints, which was popular 30-40 years ago, has generally been abandoned, as it is unnecessary in view of the excellent synovial penetration of most systemically administered antibiotics and also because it can cause a chemical synovitis.…”

“…In this regard, it needs to be appreciated that pooled data on bone concentrations comes from multiple studies using various different methods, and are not necessarily comparable. [10][11][12][13][14] With the above qualifications in mind, broad conclusions can, however, be drawn from studies of antibiotic bone penetration. Studies suggest that with standard dosing, bone concentrations exceed the MIC 50 of 2methicillin-sensitive S. aureus by more than a factor of 10 for the penicillinase-resistant penicillins (e.g.…”

Pharmacokinetic Optimisation of the Treatment of Septic Arthritis

“…17 ,[8][9][10][11][12][13][14][15][16][17][18][19][25][26][27][28] The achievable synovial fluid The synovial fluid concentration of aztreonam is at least 20 to 1000-fold that of the MIC for Escherichia coli, many times that of the MICs for most members of the Enterobacteriaceae family, and up to lO-fold that of P. aeruginosa;[ 2 0l therefore, in patients with accelerated hypersensitivity reactions to p-lactams, aztreonam is a reasonable alternative for the treatment of infections caused by susceptible organisms. 17 ,[8][9][10][11][12][13][14][15][16][17][18][19][25][26][27][28] The achievable synovial fluid The synovial fluid concentration of aztreonam is at least 20 to 1000-fold that of the MIC for Escherichia coli, many times that of the MICs for most members of the Enterobacteriaceae family, and up to lO-fold that of P. aeruginosa;[ 2 0l therefore, in patients with accelerated hypersensitivity reactions to p-lactams, aztreonam is a reasonable alternative for the treatment of infections caused by susceptible organisms.…”