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Principles of antibiotic penetration into abscess fluid
Claudia Wagner1, Robert Sauermann, Christian Joukhadar
1Division of Clinical Pharmacokinetics, Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
Abstract:
Although drainage is considered the gold standard in abscess treatment, abscesses of different sizes and locations have been successfully cured by means of antibiotic treatment alone. The penetration of an antibiotic into an encapsulated purulent lesion is limited and highly dependent on the degree of abscess maturation. In fact, in vivo pharmacokinetic data demonstrate that substantial antibiotic concentrations can be reached within abscesses in humans and animals, provided the choice of an appropriate agent and an optimal dosing regimen. However, the efficacy of antibiotics in pus may be hampered by various factors like low pH, protein binding and degradation by bacterial enzymes. This article provides a comprehensive review on conservative abscess treatment, presenting clinical data on success rates of antibiotic therapy. Antibiotic concentrations measured in abscesses of humans and animals are outlined, and theoretical considerations on the understanding of pharmacokinetics and efficacy of antibiotics in abscesses are discussed.
Insights
Antibiotic therapy can successfully treat abscesses without drainage. Achieving sufficient antibiotic concentrations in pus requires careful drug selection and dosing, despite potential challenges like low pH and bacterial enzymes.
Area of Science:
- Infectious Diseases
- Pharmacology
- Surgical Pathology
Background:
- Drainage is the standard for abscess treatment, but antibiotic-only approaches are also effective.
- Antibiotic penetration into abscesses depends on maturation and drug properties.
- In vivo studies show achievable antibiotic concentrations in abscesses with proper regimens.
Purpose of the Study:
- To review conservative abscess treatment using antibiotics alone.
- To present clinical data on antibiotic therapy success rates for abscesses.
- To discuss pharmacokinetics and efficacy of antibiotics in purulent lesions.
Main Methods:
- Comprehensive literature review of conservative abscess treatment.
- Analysis of clinical data on antibiotic therapy success rates.
- Review of in vivo pharmacokinetic data and theoretical considerations.
Main Results:
- Antibiotic treatment alone can cure abscesses of various sizes and locations.
- Substantial antibiotic concentrations can be achieved within abscesses.
- Factors like low pH, protein binding, and enzyme degradation can affect antibiotic efficacy.
Conclusions:
- Antibiotic therapy is a viable conservative option for abscess treatment.
- Optimizing antibiotic choice and dosing is crucial for efficacy.
- Understanding pharmacokinetic challenges is key to successful antibiotic treatment of abscesses.
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