Chest
Penetration of Aminoglycosides in Uninfected Pleural Exudates and in Pleural Empyemas
Section snippets
Uninfected Pleural Exudates
Patients and Experiment. The 19 patients underwent a lobectomy (17 cases) or a pneumomectomy (two cases) two to seven days (mean, 3.1 days) before investigation. Pulmonary resections were performed for bronchial carcinoma (16 cases), emphysematous bullae (one case), tuberculosis (one case), and bronchiectasis (one case). Renal function of all of the patients was normal (serum creatinine level, ≤1 mg/dl). All had postoperative pleural drainage with a chest tube and continuous suction. A single
Uninfected Pleural Exudates
Tables 1 to 3 present the concentrations of gentamicin, netilmicin, and amikacin observed in serum and uninfected pleural exudates. For gentamicin the mean peak and trough concentrations in the pleural fluid were 2.4 ± 0.3 and 1.1 ± 0.2 mg/L, respectively; the ratio of the pleural fluid and serum mean peak concentrations was 56.9 percent. The half-life of the drug in the pleural fluid was significantly longer than that of the drug in the serum (3.95 ± 0.42 vs 2.86 ± 0.14 hours; p<0.025). The
DISCUSSION
The pharmacokinetics of aminoglycosides in the pleural space after systemic administration has not been extensively investigated. Most of the studies report pleural antibiotic levels in samples taken at various intervals after the injection of the drug in different patients, which does not provide kinetic information about the pleural diffusion of the drugs. In a sterile effusion, a pleural fluid/serum concentration ratio of streptomycin, gentamicin, tobramycin, amikacin, and sisomicin ranging
ACKNOWLEDGMENTS
We thank the medical and nursing staff of the Thoracic Surgery Department at the Erasme Hospital for their help during the study. The expert laboratory assistance of Ms. M. Vanderlinden was greatly appreciated. We are grateful to Ms. L. Zech and Ms. M. Onrubia tor their competent secretarial work.
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Cited by (40)
Factors associated with recurrent bacterial empyema thoracis
2018, Asian Journal of SurgeryCitation Excerpt :Although the univariable analysis showed significant differences in some of the antibiotics administration between groups, these differences were not associated with recurrent disease in the multivariable analysis model. Most of the cases were treated with broad-spectrum antibiotics according to the British Thoracic Society guidelines,17 such as cephalosporin plus clindamycin or penicillin combined with beta-lactamase inhibitors, which have good penetration of the pleural space.18–20 In this cohort, anaerobe culture was not available; however, antibiotics to cover anaerobic infection were used in most cases.
JAID/JSC Guidelines for the Treatment of Respiratory Infectious Diseases: The Japanese Association for Infectious Diseases/Japanese Society of Chemotherapy – The JAID/JSC Guide to Clinical Management of Infectious Disease/Guideline-preparing Committee Respiratory Infectious Disease WG
2016, Journal of Infection and ChemotherapyCitation Excerpt :The penetration of aminoglycosides to the thoracic cavity is poor, and their activities reduce when the pH is low. Therefore, for pyothorax treatment, the use of aminoglycosides should be generally avoided [237–240]. The pyothorax treatment period has not been established.
Treatment of Complicated Pleural Effusions in 2013
2013, Clinics in Chest MedicineCitation Excerpt :Because of these results, little work has been done to explore intrapleural antibiotic instillation despite it being intuitively appealing, especially as little is known about antibiotic levels in fluid surrounded by thickened pleura. There is also limited understanding regarding the activity of such antibiotics in highly acidic environments, circumstances that may explain why studies have shown aminoglycoside levels to be undetectable in empyema when given intravenously.83,84 Historically, patients suspected of having pleural infection had larger chest drains inserted.
Pleural diffusion of amoxicillin 1 and vancomycin in patients treated fro post-surgical empyema
2007, Revue des Maladies RespiratoiresPleural empyema: From pharmacokinetic/pharmacodynamic parameters forwards therapeutic options
2005, Archives de PediatrieDiffusion of antibiotics into lung tissue. Critical analysis of the literature
2001, Annales Francaises d'Anesthesie et de Reanimation
Supported by a grant from Schering-Essex Brussels and from Bristol Benelux, Brussels, which also, respectively, provided gentamicin and netilmicin, and amikacin.
Presented in part at the 23rd International Conference on Antimicrobial Agents and Chemotherapy, Las Vegas, October 1983.