Pharmacokinetic aspects of antibacterial prophylaxis

Effective prophylaxis against infection can only occur when the antibacterial achieves suitable concentrations at the site of potential infection. This review discusses how the pharmacokinetics of systemically applied prophylaxis and the factors governing the distribution of locally applied antibacterials influence the outcome of prophylactic therapy. While the choice of route of administration for systemic prophylaxis rarely poses a problem, the effective concentrations required at the site of potential infection are unclear and may possibly be less than those needed for therapy of established infection. In some tissues there may be special considerations for the access of antibacterial from the blood, although for the large majority of sites the evidence is that access occurs without difficulty and is perhaps only limited by plasma protein binding of antibacterial. Locally applied antibacterials may have difficulty in reaching their site of action but this can often be overcome by their application at very high concentrations.