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ORIGINAL CONTRIBUTION AND CLINICAL INVESTIGATION
Tissue and plasma concentrations of meropenem in
diabetic foot infected patients
Mohammed Abdullah Ali (1)
Nidhal AK Mohammed Ali (2)
(1) Department of Pharmacology, College of Pharmacy,
Hawler Medical University, Iraq
(2) College of Medicine, Hawler Medical University, Iraq
Correspondence:
Nidhal AK Mohammed Ali
Department of Pharmacology, College of Pharmacy,
Hawler Medical University, Iraq
Email: nabdulqader@yahoo.co.uk
Abstract
Objective: Meropenem is a broad
antibacterial agent against most
pathogens causing diabetic foot
infections. The pharmacodynamics
parameter, time during which
antibiotic concentration remains
above the MIC for the infecting
pathogen (T>MIC) has been
recommended for good efficacy.
This study aimed to determine
meropenem concentrations in
plasma and foot infected tissues
in diabetic patients and relate
these values with microbiological
findings.
Patients and Materials: Ten
patients with diabetic foot infections
were enrolled in the study.
Microbiological examination and
the minimum inhibitory concentration
(MIC) were determined
for foot infected samples. All
patients received meropenem by
intravenous infusion of 1000 mg
for 30 minutes at 8 hourly intervals.
Blood samples were taken
after 1, 2, 4, and 8 hours of the
last meropenem dose and
the plasma meropenem concentration
was analyzed by HPLC.
Viable soft tissue samples were
obtained at time of amputation
and meropenem concentration
was determined by microbiological
assay.
Results: Meropenem attained
high concentrations in foot
tissues in excess of the MICs
of the isolated bacteria and the
mean T>MIC% was 77.5± 19.45.
Conclusion: The present data
shows good tissue penetration of
meropenem in foot tissues that
permits its recommendation for
the treatment of foot infections in
diabetic patients.
Key words: pharmacodynamics,
meropenem, T>MIC.
Introduction
Pharmacodynamics of antimicrobials
explore the relationship between the
attained drug concentrations and the
infecting organism with the clinical
outcome (1, 2).
Achieving therapeutic drug
concentrations at the site of infection
is one of the main goals of antibiotic
therapy especially where peripheral
vascular circulation is embedded in
situations such as foot infections of
diabetic patients (2, 3).
Some antibiotics when used in
the treatment of diabetic foot
infections, may attain adequate
blood levels but may not achieve
sufficient antimicrobial concentration
in infected tissues to combat
the infection leading to more
complication that may necessitate
amputation (1, 4, 5).
Choosing antibiotics for diabetic
foot infections should include an
agent active against staphylococci,
Gram-negative bacilli, Enterococcus
and anaerobic species especially in
previously treated or severe cases
as they are involved in diabetic foot
infections (6, 7, 8).
Meropenem is a broad-spectrum
carbapenem antibiotic with excellent
activity against many pathogens
associated with complicated
skin and soft tissue infections
(cSSTIs)(9).
The optimal pharmacodynamic
parameter predicting microbiologic
efficacy is the time that the drug
concentration in the blood remains
above the MIC (T> MIC) (1, 10, 11).
Pharmacokinetic studies revealed
that meropenem penetrates rapidly
and widely into a range of body
fluids and tissues (12, 13) resulting
in sufficient T>MIC in body fluids
enough to kill bacteria (11, 14) and a
regimen which provides a T>MIC of
40% of the dosing interval has
MIDDLE EAST JOURNAL OF FAMILY MEDICINE VOLUME 10 ISSUE 6
MIDDLE EAST JOURNAL OF FAMILY MEDICINE • VOLUME 7, ISSUE 10 35