The corresponding levels of cefotaxime in serum and synovial fluid were investigated in patients undergoing surgery under perioperative antibiotic medication. By investigating 32 samples a concentration band over 4 hours could be established. Clinically relevant levels of the drug could be found from 10 minutes after start of the intravenous dose with an increase up to 30 minutes. Between 30 and 90 minutes the average concentration was about 40 micrograms/ml. After 90 minutes a decrease of the concentration was found and the median lines for synovial and serum concentrations crossed at about 105 minutes. Even after 4 hours we found synovial titers of 10 to 20 micrograms/ml having therapeutical relevance. From the results we can conclude, that cefotaxime infusion of 2 g produced over hours therapeutical synovial levels being significantly over the break point of 16 micrograms/ml for bacteria susceptible to this antibiotic agent. On the other hand we strongly recommend not to wait too long with surgical intervention when a joint infection does not improve significantly in 48 hours under systemic antibiotic treatment.

Adolescent↗

PubMedDate not supplied

[Azlocillin--synovial fluid levels after intravenous doses].

The corresponding levels of azlocillin in serum and in synovial fluid in the knee-joint were investigated in patients who had undergone aseptic surgery of the lower limbs. The mean synovial fluid concentrations for azlocillin were determined on the basis of 30 samples. Clinically relevant azlocillin levels of approximately 40 mu g/ml were recorded in synovial fluid 10 minutes after start of a short infusion of 5 gm. These increased until about 90 minutes after commencement of antibiotic administration when the maximum level was attained. Subsequently synovial fluid levels decreased slowly and approximately 170 minutes after commencement of the short infusion the mean for serum and synovial concentrations corresponded. The results confirm that with an i.v. infusion of 5 g azlocillin levels can be attained for 3 hours in the synovial fluid that are above the break-point for this antibiotic of 64 mu g/ml. However, despite these good pharmacokinetic data it should be remembered that experience has shown that surgical reintervention is often necessary in addition in joint infections to achieve ultimate cure.

Adolescent↗