Tissue concentrations of an orally administered antibiotic in diabetic patients with foot infections

Storm, Annet; Bouter, K.P.; Diepersloot, R. J. A.; Banga, Jan‐Dirk; Beerens, R. G.; Erkelens, D. W.

doi:10.1093/jac/34.3.449

Cited by 8 publications

(5 citation statements)

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“…In one, four patients with diabetes and lower extremity ischemia had bone levels of ceftazidime (given parenterally prior to amputation) that were all several‐fold higher than the therapeutic concentration [17]. In another study of 12 diabetic patients with foot disorders a single dose of oral cefuroxime was given, serum levels were adequate but tissue and wound fluid samples were undetectable [18].…”

Section: Antibiotic Therapymentioning

confidence: 99%

Evidence-based antibiotic therapy of diabetic foot infections

Lipsky

1999

FEMS Immunology &Amp; Medical Microbiology

122

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In addition to proper cleansing, debridement and local wound care, foot infections in diabetic patients require carefully selected antibiotic therapy. Serious infections necessitate hospitalization for initial parenteral broad-spectrum antibiotic therapy. Appropriately selected patients with mild infections can be treated as outpatients with oral (or even topical) therapy. Initial antibiotic selection is usually empirical, but definitive therapy may be modified based on culture results and the clinical response. Therapy should nearly always be active against staphylococci and streptococci, with broader-spectrum agents indicated if Gram-negative or anaerobic organisms are likely. In infected foot tissues levels of most antibiotics, except fluoroquinolones, are often subtherapeutic. The duration of therapy ranges from a week (for mild soft tissue infections) to over 6 weeks (for osteomyelitis). Recent antibiotic trials have shown that several intravenously or orally administered agents are effective in treating these infections, with no one agent or combination emerging as optimal. Suggested regimens based on the severity of infection are provided.

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Section: Antibiotic Therapymentioning

confidence: 99%

Evidence-based antibiotic therapy of diabetic foot infections

Lipsky

1999

FEMS Immunology &Amp; Medical Microbiology

122

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“…The penetration of systemically administered antibiotics into soft tissue sites is crucial to the success of diabetic ulcer antibiotic therapy. Over recent years it has been highlighted that antibiotic plasma concentrations cannot always be accepted as a reflection of tissue concentrations, particularly at wound sites (36,41). Contradictory results have been published by Duck-worth et al (9), who found good therapeutic tissue concentrations of clindamycin in four of four diabetic patients treated for foot infections, and Seabrook (36), who found no detectable levels in similar patients using the same dose.…”

Section: Discussionmentioning

confidence: 99%

Distribution of systemically administered ampicillin, benzylpenicillin, and flucloxacillin in excisional wounds in diabetic and normal rats and effects of local topical vasodilator treatment

Cross

Thompson

Roberts

1996

Antimicrob Agents Chemother

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The present study assessed the suitability of the streptozotocin-treated diabetic rat as a model for the study of diabetes-impaired wound healing. The distribution of three antibiotics, ampicillin, benzylpenicillin, and flucloxacillin, in wound and adjacent tissue sites on the abdomens and legs of normal and diabetic rats was determined 30 min after intravenous administration of a single bolus containing 50 mg of all three antibiotics per kg of body weight. Tissue/plasma ratios showed that antibiotic tissue penetration appeared to be related to protein binding. The treatment of wound sites with vasodilators (1% solution) to increase local blood flow and antibiotic delivery to the site was then determined and appeared to be more effective with endothelium-independent sodium nitroprusside than with endothelium-dependent acetylcholine in diabetic rats. These results suggest that coadministration of topical vasodilators to wound sites in neuropathic diabetic patients undergoing antibiotic therapy for infected ulcers could increase antibiotic delivery to wound tissue sites.

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“…Ideally, patients with inadequate blood flow to an affected limb should have revascularization done before beginning antibiotic therapy. Agents that penetrate into tissues effectively such as the fluoroquinolones and ampicillin/sulbactam should be considered as treatment options 38–42 . Ofloxacin has demonstrated significant ability to penetrate diabetic infected tissue 42 .…”

Section: Treatmentmentioning

confidence: 99%

“…Agents that penetrate into tissues effectively such as the fluoroquinolones and ampicillin/sulbactam should be considered as treatment options 38–42 . Ofloxacin has demonstrated significant ability to penetrate diabetic infected tissue 42 . A study of nine diabetic patients given 800 mg of oral ofloxacin, 120 to 150 minutes before surgery with subsequent tissue and blood specimens taken during surgery found mean serum ofloxacin concentrations of 7.0 ± 3.5 mg/L; mean tissue concentrations were 11.5 ± 8.4 mg/kg.…”

Section: Treatmentmentioning

confidence: 99%