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Antibiotic Tissue Penetration in Diabetic Foot Infections

A Review of the Microdialysis Literature and Needs for Future Research

Amanda Ray DPM1, Danielle Malin DPM1, David P. Nicolau PharmD2,3, and Dora E. Wiskirchen PharmD, BCPS4,5
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  • 1 Section of Podiatric Surgery, Department of Surgery, Saint Francis Hospital and Medical Center, Hartford, CT.
  • | 2 Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT.
  • | 3 Division of Infectious Diseases, Hartford Hospital, Hartford, CT.
  • | 4 Department of Pharmacy Practice and Administration, School of Pharmacy, University of Saint Joseph, Hartford, CT.
  • | 5 Department of Pharmacy, Saint Francis Hospital and Medical Center, Hartford, CT.
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Although many antimicrobial agents display good in vitro activity against the pathogens frequently implicated in diabetic foot infections, effective treatment can be complicated by reduced tissue penetration in this population secondary to peripheral arterial disease and emerging antimicrobial resistance, which can result in clinical failure. Improved characterization of antibiotic tissue pharmacokinetics and penetration ratios in diabetic foot infections is needed. Microdialysis offers advantages over the skin blister and tissue homogenate studies historically used to define antibiotic penetration in skin and soft-tissue infections by defining antibiotic penetration into the interstitial fluid over the entire concentration versus time profile. However, only a select number of agents currently recommended for treating diabetic foot infections have been evaluated using these methods, which are described herein. Better characterization of the tissue penetration of antibiotic agents is needed for the development of methods for maximizing the pharmacodynamic profile of these agents to ultimately improve treatment outcomes for patients with diabetic foot infections.

Corresponding author: David P. Nicolau, PharmD, Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour St, Hartford, CT 06102. (E-mail: david.nicolau@hhchealth.org)