Measurement of the concentration of three antituberculosis drugs in the focus of spinal tuberculosis |
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Authors: | Zhaohui Ge Zili Wang Mingji Wei |
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Institution: | (1) Department of Orthopedic Surgery, Hospital of the Ningxia Medical School, 804 Shengli Street, 750004 Yinchuan, Ningxia, People’s Republic of China;(2) Institute of Pharmacologic Research, Beijing University, 38 Xueyuan Street, 100083 Beijing, China |
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Abstract: | This is an experimental study on the distribution of antituberculosis drugs such as rifampin, isoniazid, and pyrazinamide
in pathologic vertebrae of spinal tuberculosis in order to provide the regimen of chemotherapy and surgical treatment of spinal
tuberculosis. The distribution of antituberculosis drugs in pathologic vertebral tissues matters greatly to the clinical effect
of spinal tuberculosis’ treatment. However, few pharmacokinetic studies and clinical reports about the concentrations of antituberculosis
drugs in vertebral foci have been published so far. Twenty-four patients with spinal tuberculosis were divided into sclerotic
group (n = 15) or non-sclerotic group (n = 9) according to radiographic features of lesion. All patients received chemotherapy with 2HRZ/2·5H2R2Z2 for a duration of 4.5 months. Four weeks after chemotherapy all patients underwent surgery and the specimen of serum, ilium,
and pathologic vertebral tissues, including sclerotic wall, subnormal osseous tissue, and foci were obtained during operation
in 120–130 and 180–190 min after oral intake in the morning, respectively. The levels of three drugs in the specimen were
measured using HPLC method. The concentration levels of isoniazid, rifampin and pyrazinamide varied greatly in different tissues
of spinal tuberculosis, of which the bactericidal concentration values of isoniazid and rifampin and fivefold minimal inhibitory
concentration (MICs) of pyrazinamide were found in subnormal vertebral bone and self-contrast ilium, the MICs of all drugs
were found in sclerotic wall outside foci, and undetected level was found in foci inside the sclerotic wall. To patients without
vertebral sclerotic wall around the foci, the isoniazid in foci was of bactericidal level and rifampin and pyrazinamide in
foci corresponded to the MICs respectively. The sclerotic bone of affected vertebra plays an important role in blocking the
antituberculosis drug’s penetration into tuberculosis focus. |
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Keywords: | Spine Tuberculosis Isoniazid Rifampicin Pyrazinamide High performance liquid |
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