Tissue concentration of clindamycin and gentamicin near ischaemic ulcers with transvenous injection in Bierʹs arterial arrest

Background In the treatment of patients with inflamed ischaemic ulcers in peripheral arterial occlusive disease, high tissue concentrations of antibiotics (TCA) are important. With local transvenous pressure injection in Biersʹ arterial arrest (TVA-Bier) higher TCAs are assumed to be obtained but they have not been measured. Methods Two groups of 16 patients each with ischaemic foot ulcers were studied. In one group, patients received a mean of 284 (SD 116) mg gentamicin and in the other, 1200 mg clindamycin. The antibiotics were given intravenously, intra-arterially, and by TVA-Bier in a randomised order at intervals of 48 hours. Biopsy samples were taken from the edge of the ulcers 20 minutes and 3 hours after TVA-Bier, and 1 hour and 3 hours after intravenous and intra-arterial injection. At the same times blood samples were taken. Findings TCAs of gentamicin and clindamycin with TVA-Bier were significantly higher compared with intravenous or intra-arterial injection. Median TCA-enhancing factor of clindamycin achieved by TVA-Bier at 20 min 1 hour was 18 3 and 14 1 versus intravenous and intra-arterial infusion, respectively, and at 3 hours 7 3 and 5 6, respectively. The median TCA-enhancing factor for gentamicin by TVA-Bier versus intravenous and intra-arterial application was, at 1 hour 20 min, 9 4 and 9 7, respectively, and at 3 hours 1 2 and 1 7, respectively. Interpretation Higher TCAs could be achieved with TVA-Bier than with intravenous or intra-arterial infusion. TCAs were lower when using gentamicin and higher with clindamycin.