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Penetration of tobramycin into infected extravascular fluids and its therapeutic effectiveness
Abstract:
The aminoglycoside antibiotic tobramycin was given intramuscularly to 15 patients with infected body fluids (empyema in five patients, peritonitis in five, peritonitis and empyema in one, tracheobronchitis in three, and infection of the pacemaker pocket in one). The infecting bacteria included Pseudomonas aeruginosa, Klebsiella, Enterobacter, Serratia, Escherichia coli, Proteus species, and Staphylococcus aureus. The mean dose of tobramycin was 1.7 mg/kg given intramuscularly every 8 hr for nine to 10 days. Levels of tobramycin in specimens of serum and infected body fluid obtained simultaneously were measured at various intervals after a dose of the antibiotic. Comparison was made between levels of tobramycin and minimal inhibitory concentrations (MICs) of the infecting bacteria. Bacteriological and clinical failures were common if the level in body fluid did not exceed the MIC. In patients with levels of tobramycin in body fluid that were higher than the MIC, cures were frequent. Drainage of infected body fluids is a necessary part of successful therapy of these infections.
Insights
Achieving adequate tobramycin levels in infected body fluids is crucial for treating serious bacterial infections. Higher drug concentrations exceeding the minimal inhibitory concentration (MIC) correlated with successful patient outcomes.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Microbiology
Background:
- Aminoglycoside antibiotics like tobramycin are used for severe bacterial infections.
- Monitoring drug levels in body fluids is essential for effective treatment.
- Infections involving body fluids pose significant therapeutic challenges.
Purpose of the Study:
- To evaluate the efficacy of intramuscular tobramycin in patients with infected body fluids.
- To correlate tobramycin levels in body fluids with minimal inhibitory concentrations (MICs) of infecting pathogens.
- To determine the impact of drug levels on clinical and bacteriological outcomes.
Main Methods:
- Intramuscular tobramycin administration to 15 patients with various infections (empyema, peritonitis, tracheobronchitis, etc.).
- Measurement of tobramycin serum and infected body fluid levels at various intervals post-dose.
- Comparison of measured tobramycin levels against MICs of isolated bacteria (Pseudomonas aeruginosa, Klebsiella, E. coli, etc.).
Main Results:
- Bacteriological and clinical failures were frequent when tobramycin levels in body fluid did not exceed the MIC.
- Successful treatment outcomes were observed in patients where body fluid tobramycin levels surpassed the MIC.
- Drainage of infected body fluids was identified as a critical component of successful therapy.
Conclusions:
- Therapeutic drug monitoring of tobramycin in infected body fluids is vital for optimizing treatment efficacy.
- Maintaining tobramycin concentrations above the MIC in infected sites is predictive of successful clinical response.
- Adjunctive measures, such as surgical drainage, are necessary for managing complex fluid-based infections.