PENETRATION OF CLINDAMYCIN AND METRONIDAZOLE INTO INFLAMED APPENDICEAL TISSUE

Objective: To calculate the penetration of clindamycin and metronidazo le into inflamed appendiceal tissue. Design: Prospective study. Settin g: Teaching hospital, Israel. Subjects: 20 Consecutive men and women o perated on for acute appendicitis. Interventions: Appendicectomy. Each patient was given three intravenous injections of gentamicin 80 mg co mbined with either clindamycin 600 mg or metronidazole 500 mg immediat ely before operation over a period of 15 minutes. Main outcome measure s: Serum and tissue concentrations of the antibiotics. Results: There was no significant difference between the mean serum concentrations of the drugs (clindamycin 17.86 mu g/ml and metronidazole 9.75 mu g/ml) but the mean tissue concentrations of clindamycin (10.41 mu g/g in the base and 9.86 mu g/g in the tip of the appendix) were significantly h igher than those of metronidazole (5.65 mu g/g in the base and 5.89 mu g/g in the tip; p = 0.02 and p = 0.05, respectively). Tissue concentr ations of clindamycin and serum concentration of both drugs were more than twice their MIC(90). The tissue concentrations of metronidazole w ere close to its MIC(90). Conclusions: Clinical trials are necessary b efore any conclusion about therapeutic superiority of one or other age nt can be drawn.