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Skin concentrations of phenoxymethylpenicillin in patients with erysipelas
A C Sjöblom1, J Bruchfeld, B Eriksson
1Dept. of Infectious Diseases, Roslagstull Hospital, Stockholm, Sweden.
Abstract:
In 45 patients hospitalized with febrile erysipelas that had been treated with oral penicillin, punch biopsies of infected skin were performed and analysed for phenoxymethylpenicillin (pcV) concentrations. The curves for the concurrent serum and tissue levels followed the same course, indicating a rapid diffusion of pcV from serum into tissue. Penicillin concentrations in infected skin exceeded the minimal inhibitory concentrations (MIC) of the streptococci isolated for the first 4 h after tablet ingestion. Venous insufficiency was highly prevalent and pcV concentrations in affected patients were slightly but not significantly higher. A theoretical basis for the successful treatment of erysipelas with oral penicillin is therefore at hand.
Insights
Oral penicillin effectively treats erysipelas by achieving high concentrations in infected skin tissue. Phenoxymethylpenicillin (pcV) rapidly diffuses from serum, exceeding minimal inhibitory concentrations for streptococci for 4 hours post-ingestion.
Area of Science:
- Pharmacology
- Dermatology
- Infectious Diseases
Background:
- Febrile erysipelas is a bacterial skin infection often treated with penicillin.
- Understanding drug penetration into infected tissue is crucial for treatment efficacy.
Purpose of the Study:
- To quantify phenoxymethylpenicillin (pcV) concentrations in infected skin tissue of patients with febrile erysipelas.
- To determine the correlation between serum and tissue pcV levels.
- To assess if tissue pcV levels exceed the minimal inhibitory concentrations (MIC) of causative streptococci.
Main Methods:
- Punch biopsies of infected skin were obtained from 45 hospitalized patients treated with oral penicillin.
- Phenoxymethylpenicillin (pcV) concentrations were measured in both serum and tissue samples.
- Concurrent serum and tissue levels were analyzed over time.
Main Results:
- Serum and tissue pcV concentrations exhibited parallel trends, indicating rapid diffusion into infected skin.
- Penicillin concentrations in infected skin surpassed the MIC of isolated streptococci for the initial 4 hours after oral administration.
- Patients with venous insufficiency showed slightly, though not significantly, higher pcV concentrations.
Conclusions:
- Oral phenoxymethylpenicillin (pcV) demonstrates rapid and effective penetration into infected skin tissue in erysipelas patients.
- Achieved tissue concentrations support the clinical efficacy of oral penicillin for treating febrile erysipelas.
- The study provides a pharmacokinetic basis for the successful use of oral penicillin in erysipelas management.