title: Cloxacillin concentrations in serum, subcutaneous fat, and muscle in patients with chronic critical limb ischemia.
abstract: BACKGROUND
  Patients suffering from critical limb ischemia (CLI) have poor wound healing in the ankle and foot areas. Secondary wound infections are frequent and often treated with prolonged courses of antibiotics.
  
  
  OBJECTIVE
  This study set out to investigate to what extent the unbound fraction of 4 g of cloxacillin i.v. reaches its target organ in poorly vascularized tissues, i.e., the calf and foot of patients suffering from CLI.
  
  
  METHODS
  Cloxacillin concentrations were measured by HPLC in serum and in microdialysis samples from skin and muscle of the lower part of the calf and as reference subcutaneously at the pectoral level in eight patients suffering from CLI (four males, four females, mean age 78 years, range 66-85 years) and in three healthy controls (two females, one male, mean age 67, range 66-68 years).
  
  
  RESULTS
  In patients suffering from CLI, the tissue penetration of cloxacillin after a single 4 g dose was comparable to that of healthy controls, despite impaired blood circulation.
  
  
  CONCLUSIONS
  The reduced blood flow in the peripheral vessels of the CLI patients presented here apparently is not the rate-limiting factor for delivery or tissue penetration of cloxacillin.
authors.affiliation: Department of Surgery, Örebro University Hospital, Örebro, Sweden, thomas.b.jonsson@gmail.com.
authors.forename: T B
authors.initials: TB
authors.lastname: Jonsson
authors.forename: T K
authors.initials: TK
authors.lastname: Nilsson
authors.forename: L H
authors.initials: LH
authors.lastname: Breimer
authors.forename: J
authors.initials: J
authors.lastname: Schneede
authors.forename: B
authors.initials: B
authors.lastname: Arfvidsson
authors.forename: L
authors.initials: L
authors.lastname: Norgren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000097:blood / Q000493:pharmacokinetics*; D002908:Chronic Disease; D003023:Cloxacillin / Q000097:blood / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000378:metabolism* / Q000628:therapy; D007866:Leg / Q000098:blood supply; D008297:Male; D018482:Muscle, Skeletal / Q000378:metabolism; D050151:Subcutaneous Fat / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D003023:Cloxacillin