Penetration of clindamycin and metronidazole into inflamed appendiceal tissue.
OBJECTIVE
To calculate the penetration of clindamycin and metronidazole into inflamed appendiceal tissue.


METHODS
Prospective study.


METHODS
Teaching hospital, Israel.


METHODS
20 Consecutive men and women operated on for acute appendicitis.


METHODS
Appendicectomy. Each patient was given three intravenous injections of gentamicin 80 mg combined with either clindamycin 600 mg or metronidazole 500 mg immediately before operation over a period of 15 minutes.


METHODS
Serum and tissue concentrations of the antibiotics.


RESULTS
There was no significant difference between the mean serum concentrations of the drugs (clindamycin 17.86 micrograms/ml and metronidazole 9.75 micrograms/ml) but the mean tissue concentrations of clindamycin (10.41 micrograms/g in the base and 9.86 micrograms/g in the tip of the appendix) were significantly higher than those of metronidazole (5.65 micrograms/g in the base and 5.89 micrograms/g in the tip; p = 0.02 and p = 0.05, respectively). Tissue concentrations of clindamycin and serum concentration of both drugs were more than twice their MIC90. The tissue concentrations of metronidazole were close to its MIC90.


CONCLUSIONS
Clinical trials are necessary before any conclusion about therapeutic superiority of one or other agent can be drawn.
Department of Surgery A, Assaf Harofeh Medical Center, Zerifin, Israel.
Y
Y
Levy
S A
SA
Berger
A
A
Gorea
A
A
Shnaker
R
R
Orda
D000328:Adult; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001064:Appendicitis / Q000378:metabolism* / Q000601:surgery*; D001065:Appendix / Q000378:metabolism*; D002981:Clindamycin / Q000493:pharmacokinetics* / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000493:pharmacokinetics / Q000627:therapeutic use; D005260:Female; D005839:Gentamicins / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000493:pharmacokinetics* / Q000627:therapeutic use; D011446:Prospective Studies
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D008795:Metronidazole; D002981:Clindamycin