title: Influx of antibiotics into diabetic legs with plantar ulcerations: regional and systemic Netilmycin levels compared after retrograde-venous and systemic-venous application.
abstract: Retrograde venous perfusions (RVP) of antibiotics were proven to be therapeutically more effective than systemic venous infusions (SVI) in patients with infected diabetic neuropathic plantar ulcers (DNPU: no additional macronagiopathy of leg arteries). In order to study some pharmakokinetic features of RVP application paratibial tissue levels of Netilmycin (NL; from suction blister fluid) and cubital venous NL were compared under each SVI and RVP therapy in 8 patients with DNPU. Tissue (11.6 +/- 6.4 micrograms/l) were significantly higher (p < 0.001) an within the therapeutic range after RVP (SVI: 4.31 +/- 1.68). In ulcer transsudate (RVP only; n = 4) NL mounted to 36.4 +/- 11.6 microgram/ml. Peak and base NL in cubital blood were within the normal range for both SVI and RVP (no significant difference). The date indicate that RVP is superior to SVI application of Netilmycin (and probably other antibiotics) as surmounting the damaged microcirculation in DNPU to achieve effective drug levels in the target tissue.
authors.affiliation: Department of Dermatology, University of Erlangen-Nuremberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Seidel
authors.forename: S
authors.initials: S
authors.lastname: Bühler-Singer
authors.forename: J
authors.initials: J
authors.lastname: Tacke
authors.forename: O P
authors.initials: OP
authors.lastname: Hornstein
mesh_terms: D000368:Aged; D001800:Blood Specimen Collection / Q000295:instrumentation; D010478:Chemotherapy, Cancer, Regional Perfusion; D017719:Diabetic Foot / Q000097:blood* / Q000188:drug therapy; D005260:Female; D005528:Foot / Q000098:blood supply; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009428:Netilmicin / Q000008:administration & dosage / Q000493:pharmacokinetics*
chemical_list: D009428:Netilmicin