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[Diffusion of trimethoprim and sulfamethoxazole into the pleural fluid]
Abstract:
The level of Trimethoprim (TMP) and of Sulfamethoxazole (SMZ) in the fluid of both pleural effusion and plasma was determined in 7 patients on the first day of treatment consisting of two daily doses of 160 mg TMP and 800 mg SMZ. In 4 subjects, the levels were determined again on the third (J3) and fifth day of treatment (J5). Thus with TMP the ratio of pleural/plasma drug levels rose progressively from the first day of treatment to attain by 12 hours a mean value of 0.79 +/- 0.16; subsequently it stayed at about the same level for day 3 (J3) and day 5 (J5). As for SMZ, the ratio of the pleural plasma drug level reached a maximum at 8 hours on the first day of treatment (0.53 +/- 0.12) then rose progressively on day 3 (J3 0.58 +/- 0.06) and on day 5 to 0.71 (+/- 0.08). The levels of TMP in the pleural fluid were below those which are usually described in bronchial secretions. On the other hand those of SMZ are appreciably raised.
Insights
This study measured Trimethoprim (TMP) and Sulfamethoxazole (SMZ) levels in pleural effusion and plasma. Both antibiotics achieved significant pleural fluid concentrations, with SMZ levels being notably high.
Area of Science:
- Pharmacokinetics
- Infectious Diseases
- Pulmonary Medicine
Context:
- Pleural effusions are common complications of various infections and inflammatory conditions.
- Understanding antibiotic penetration into pleural fluid is crucial for effective treatment.
- Limited data exists on the pharmacokinetics of Trimethoprim/Sulfamethoxazole in human pleural effusions.
Purpose:
- To determine the concentrations of Trimethoprim (TMP) and Sulfamethoxazole (SMZ) in pleural effusion fluid relative to plasma.
- To assess the penetration and accumulation of TMP and SMZ in pleural fluid over the course of treatment.
Summary:
- This study analyzed TMP and SMZ levels in pleural effusion and plasma from 7 patients receiving standard doses.
- Drug levels were measured on days 1, 3, and 5 of treatment.
- The pleural fluid to plasma ratio for TMP increased progressively, reaching 0.79 by 12 hours on day 1 and remaining stable. The ratio for SMZ peaked at 0.53 on day 1 and increased to 0.71 by day 5.
- TMP levels in pleural fluid were lower than typically found in bronchial secretions, while SMZ levels were significantly elevated.
Impact:
- The findings suggest that SMZ achieves substantial concentrations in pleural effusions, potentially contributing to effective treatment of susceptible infections.
- The data provides valuable pharmacokinetic insights for optimizing antibiotic therapy in patients with pleural effusions.
- Further research could explore the clinical efficacy of TMP/SMZ in treating specific pleural space infections.