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Penetration and decay of meropenem into the human aqueous humor and vitreous
J Schauersberger1, M Amon, A Wedrich
1Universitätsklinik für Augenheilkunde, Vienna, Austria.
Abstract:
The aim of this study was to determine the penetration of intravenously administered meropenem into the human aqueous humor and vitreous. Thirty patients about to undergo cataract surgery and fourteen patients about to undergo vitrectomy received a 2 g dose of meropenem before surgery. Specimens of aqueous humor or vitreous and blood were obtained intraoperatively and analyzed by high performance liquid chromatography (HPLC). The study was designed as a non-randomized prospective trial. Thirty min to 12 hr after administration, mean aqueous humor levels of 13.4 and 1.1 mg/l and vitreous levels between 8.94 and 1.08 mg/l were found, respectively. The peak concentrations are distinctly above the in vitro measured minimum inhibitory concentration of meropenem for 90% (MIC90) of almost all relevant gram-positive and gram-negative organisms, including Pseudomonas aeruginosa and Enterobacteriaceae. With regard to its broad spectrum, high antibacterial activity, and good penetration into ocular fluids, meropenem seems to be an alternative to currently used systemic drugs. Its usefulness in perioperative prophylaxis, as initial therapy after perforating or penetrating injuries, or in the therapy of bacterial endophthalmitis has yet to be proved.
Insights
Intravenous meropenem effectively penetrates the human eye, reaching concentrations above minimum inhibitory levels for many bacteria. This suggests meropenem
Area of Science:
- Ophthalmology
- Pharmacology
- Infectious Diseases
Background:
- Systemic antibiotics are crucial for treating ocular infections.
- Understanding antibiotic penetration into ocular tissues is vital for effective treatment.
Purpose of the Study:
- To quantify the penetration of intravenous meropenem into human aqueous humor and vitreous.
- To assess meropenem's potential as a treatment for ocular infections.
Main Methods:
- Prospective, non-randomized trial involving 44 patients undergoing ocular surgery.
- Intravenous meropenem (2g) administered preoperatively.
- Analysis of aqueous humor, vitreous, and blood samples using high-performance liquid chromatography (HPLC).
Main Results:
- Meropenem achieved mean aqueous humor concentrations of 13.4 mg/L and vitreous concentrations up to 8.94 mg/L.
- Peak concentrations were significantly higher than the minimum inhibitory concentration (MIC90) for most relevant Gram-positive and Gram-negative bacteria.
- Meropenem demonstrated good penetration into ocular fluids.
Conclusions:
- Intravenous meropenem exhibits favorable penetration into human aqueous humor and vitreous.
- Achieved concentrations suggest potent antibacterial activity against a broad spectrum of pathogens.
- Meropenem may be a viable alternative to current systemic therapies for certain ocular conditions, though further clinical proof is needed.