Objective: To calculate the penetration of clindamycin and metronidazole into inflamed appendiceal tissue.
Design: Prospective study.
Setting: Teaching hospital, Israel.
Subjects: 20 Consecutive men and women operated on for acute appendicitis.
Interventions: 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.
Main Outcome Measures: 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.
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