Plasma and bone concentrations of cefuroxime and flucloxacillin: Oral versus parenteral administration in 20 arthroplasties

Ferrero, M Miguel; Vree, T. B.; Baars, A. M.; Slooff, T. J. J. H.

doi:10.3109/17453679308993684

Cited by 10 publications

(4 citation statements)

References 30 publications

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“…On the other hand, mean femoral head, neck, and acetabulum concentrations in THA were 11.7 AE7.7, 10.1 AE4.9, and 27.1 AE15.9 mg/mL, respectively. Another study compared the penetration of oral versus IV formulations of flucloxacillin in 20 TKA/THA patients (Ferrero et al, 1993). Bone concentration was detected only after the 2 g IV dose with mean concentration of 14.1 AE7.2 mg/mL.…”

Section: Antistaphylococcal Penicillinsmentioning

confidence: 99%

Antibiotic penetration into bone and joints: An updated review

Thabit

Fatani

Bamakhrama

et al. 2019

International Journal of Infectious Diseases

244

155

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A B S T R A C TTreatment of bone and joint infections can be challenging as antibiotics should penetrate through the rigid bone structure and into the synovial space. Several pharmacokinetic studies measured the extent of penetration of different antibiotics into bone and joint tissues. This review discusses the results of these studies and compares them with minimum inhibitory concentrations (MIC) of common pathogens implicated in bone and joint infections in order to determine which antibiotics may have a greater potential in the treatment of such infections. Clinical outcomes were also evaluated as data were available. More than 30 antibiotics were evaluated. Overall, most antibiotics, including amoxicillin, piperacillin/tazobactam, cloxacillin, cephalosporins, carbapenems, aztreonam, aminoglycosides, fluoroquinolones, doxycycline, vancomycin, linezolid, daptomycin, clindamycin, trimethoprim/sulfamethoxazole, fosfomycin, rifampin, dalbavancin, and oritavancin, showed good penetration into bone and joint tissues reaching concentrations exceeding the MIC 90 and/or MIC breakpoints of common bone and joint infections pathogens. Few exceptions include penicillin and metronidazole which showed a lower than optimum penetration into bones, and the latter as well as flucloxacillin had poor profiles in terms of joint space penetration. Of note, studies on joint space penetration were fewer than studies on bone tissue penetration. Although clinical studies in osteomyelitis and septic arthritis are not available for all of the evaluated antibiotics, these pharmacokinetic results indicate that agents with good penetration profiles would have a potential utilization in such infections.

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Section: Antistaphylococcal Penicillinsmentioning

confidence: 99%

Antibiotic penetration into bone and joints: An updated review

Thabit

Fatani

Bamakhrama

et al. 2019

International Journal of Infectious Diseases

244

155

View full text Add to dashboard Cite

show abstract

“…As an example, the serum trough levels reported by Gath et al were 15±5.9 mg/L (5), while the peak levels reported by Dijkmans et al were 22-26 mg/L (range, 7-53 mg/L) (6). Thus, while most intravenous (and probably intramuscular) β-lactams reach the necessary MIC for MSSA in bone (57)(58)(59)(60)(61), this might not be the case with oral administration. One cause for the relatively low levels achieved with oral FLU is likely the innate variabilities in its gastrointestinal absorption (6).…”

Section: Discussionmentioning

confidence: 96%

“…One cause for the relatively low levels achieved with oral FLU is likely the innate variabilities in its gastrointestinal absorption (6). Among humans, 9% largely fail to absorb FLU and another 17% are poor absorbers (61). A pharmacologic in vivo study from the Netherlands (61) compared levels of cefuroxime and FLU when given by oral versus parenteral routes in plasma and intraoperative bone during twenty hip and knee arthroplasty surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…The effectiveness of antibiotic treatment for OM is complex, depending on the interaction of drug, host, microbial agent and other aspects. For example, it is disturbing that Alvarez-Ferrero et al (61) failed to detect a measurable osseous concentration in vivo after administration of oral FLU, but they did not address the large technical and analytical problems in assessing drug concentrations in bone (61). There are likely also differences in antibiotic concentrations in cancellous versus cortical versus mixed homogenized bone, in infected versus non-infected bone, and issues related to blood contamination during bone sampling.…”

Section: Discussionmentioning

confidence: 99%

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Oral Flucloxacillin for Treating Osteomyelitis: A Narrative Review of Clinical Practice

Preiss

Kriechling

Montrasio

et al. 2020

J. Bone Joint Infect.

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Abstract. Flucloxacillin (FLU) administered by the oral route is widely used for treating various infections, but there are no published retrospective or prospective trials of its efficacy, or its advantages or disadvantages compared to parenteral treatment or other antibiotics for treating osteomyelitis. Based on published in vitro data and expert opinions, other non-β-lactam oral antibiotics that have better bone penetration are generally preferred over oral FLU. We reviewed the literature for studies of oral FLU as therapy of osteomyelitis (OM), stratified by acute versus chronic and pediatric versus adult cases. In striking contrast to the prevailing opinions and the few descriptive data available, we found that treatment of OM with oral FLU does not appear to be associated with more clinical failures compared to other oral antibiotic agents. Because of its narrow antibiotic spectrum, infrequent severe adverse effects, and low cost, oral FLU is widely used in clinical practice. We therefore call for investigators to conduct prospective trials investigating the effectiveness and potential advantages of oral FLU for treating OM.

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Relationship between plasma and bone concentrations of cefuroxime and flucloxacillin three different parenteral administrations compared in 30 arthroplasties

Ferrero

Vree

Kolmer

et al. 1994

Biopharm & Drug Disp

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(i) The objective was to determine the range of bone levels of cefuroxime and flucloxacillin achieved after one intravenous (IV) administration of different dosages of cefuroxime and flucloxacillin. (ii) Six groups of five patients participated in the study. The first three groups (A-C) received respectively 1500 mg, 1000 mg, and 500 mg cefuroxime intravenously and the second three groups (D-F) received 2000 mg, 1500 mg, and 1000 mg flucloxacillin intravenously. (iii) Parenteral administration of cefuroxime and flucloxacillin resulted in measurable bone concentrations in all patients. (iv) Large inter-individual variation in bone concentration was observed. (v) The bone concentrations of IV cefuroxime were higher (1500 mg, p = 0.0057; 1000 mg, p = 0.0260) than those of flucloxacillin. The bone concentrations of cefuroxime and flucloxacillin were dose dependent.

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Plasma and bone concentrations of cefuroxime and flucloxacillin: Oral versus parenteral administration in 20 arthroplasties

Cited by 10 publications

References 30 publications

Antibiotic penetration into bone and joints: An updated review

Antibiotic penetration into bone and joints: An updated review

Oral Flucloxacillin for Treating Osteomyelitis: A Narrative Review of Clinical Practice

Relationship between plasma and bone concentrations of cefuroxime and flucloxacillin three different parenteral administrations compared in 30 arthroplasties

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