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Penetration of aminoglycosides in uninfected pleural exudates and in pleural empyemas
J P Thys1, P Vanderhoeft, A Herchuelz
1Infectious Diseases Clinic, Cliniques Universitaires de Bruxelles, Belgium.
Abstract:
The concentrations of gentamicin, netilmicin, and amikacin were determined after one single intravenous injection in uninfected pleural fluid after thoracotomy and in purulent pleural empyemas. The mean peak concentrations in the pleural fluid after the injection of gentamicin (1.5 mg/kg), netilmicin (2.0 mg/kg), and amikacin (7.5 mg/kg) were 2.9 +/- 0.3 mg/L, 3.7 +/- 0.8 mg/L, and 11.0 +/- 3.1 mg/L, respectively. The pleural penetration of the drugs was very high (from 80.0 to 99.1 percent). By contrast, gentamicin and netilmicin were not detectable in empyema pus; in this exudate the mean peak level of amikacin was 5.7 +/- 2.2 mg/L, with the penetration of this drug being 31.0 percent. The concentrations of parenterally administered aminoglycosides are substantially lower in empyema pus than in sterile pleural fluid. The possibility of poor pleural penetration of some aminoglycosides, as well as the presence of local conditions in pleural empyema unfavorable to the bioactivity of these drugs, must be kept in mind when treating pleural infections.
Insights
Aminoglycoside antibiotics like gentamicin, netilmicin, and amikacin show high pleural fluid penetration but poor levels in empyema pus. This suggests challenges in treating pleural infections with these drugs.
Area of Science:
- Pharmacology
- Infectious Diseases
- Pulmonology
Background:
- Pleural infections, particularly empyema, pose treatment challenges.
- Aminoglycosides are commonly used antibiotics for bacterial infections.
Purpose of the Study:
- To determine the concentrations and pleural penetration of gentamicin, netilmicin, and amikacin.
- To compare drug levels in sterile pleural fluid versus purulent empyema pus.
Main Methods:
- Single intravenous injection of gentamicin, netilmicin, and amikacin in patients.
- Measurement of drug concentrations in pleural fluid and empyema pus.
- Calculation of pleural penetration percentages.
Main Results:
- High peak concentrations and penetration (>80%) in sterile pleural fluid for all three drugs.
- Gentamicin and netilmicin were undetectable in empyema pus.
- Amikacin showed lower peak concentrations (5.7 mg/L) and penetration (31.0%) in empyema pus compared to sterile fluid.
Conclusions:
- Aminoglycoside concentrations are significantly lower in empyema pus than in sterile pleural fluid.
- Poor pleural penetration and unfavorable local conditions in empyema may limit aminoglycoside efficacy.
- Consideration of these factors is crucial for effective treatment of pleural infections.