Endothelial cell compatibility of clindamycin, gentamicin, ceftriaxone andteicoplanin in Bier's arterial arrest

In patients with infected diabetic foot lesions, and gangrenous, peripheral , occlusive arterial disease, it is important to achieve high concentration s of antibiotics in the tissues, as the extent of amputation is often influ enced by the presence of infection. Local transvenous pressure injection of antibiotics, in Bier's arterial arrest, allows high local tissue concentra tions to be attained in the extremities. Information on the endothelial com patibility of antibiotics in high concentrations combined with the effect o f reperfusion injury following tissue hypoxia is lacking. To evaluate the e ffect of clindamycin, gentamicin, ceftriaxone and teicoplanin injected in B ier's arterial arrest, on endothelial cells, an in-vitro model using human umbilical venous endothelial cells (HUVEC) has been devised. The intracellu lar levels of purine nucleotides, reflecting DNA/RNA synthesis, energy prod uction and signal transduction of these cells were measured by means of hig h-performance liquid chromatography. Incubation of cells with in mg/mL clin damycin, gentamicin, ceftriaxone and teicoplanin for 20 min resulted in no significant decline of intracellular purines. Levels of purines obtained af ter exposure of the cells to 0.1 mmol/L hydrogen peroxide (H2O2), to simula te reperfusion injury, were not significantly different from those obtained from cells allowed to recover after antibiotic exposure. These findings in dicate that the infusion of high doses of antibiotics, during Bier's arteri al arrest, is compatible with maintenance of endothelial cell function, eve n in the presence of increased free radical activity, provided the exposure is limited to 20 min.