From the Guidelines
No, antibiotics should not be directly infused into body cavities, such as pleural spaces or joints, as this is not a recommended practice according to the provided evidence 1.
Rationale
- The British Thoracic Society guidelines for the management of pleural infection state that there is no need to administer antibiotics directly into the pleural space, as beta-lactams show good penetration of the pleural space 1.
- The guidelines recommend choosing antibiotics based on the results of pleural fluid culture and sensitivities, and selecting drugs that cover community-acquired bacterial pathogens and anaerobic organisms 1.
- In the context of fracture-related infections, local application of antimicrobials at the site of infection through different carriers has gained attention, but this is typically done using commercial formulations of antibiotics incorporated into materials such as PMMA, collagen fleeces, or bone void fillers, rather than direct infusion into body cavities 1.
- The use of antibiotic prophylaxis in thoracostomy has a clear role in preventing infectious complications in chest trauma patients, but this is typically administered systemically, rather than directly into the pleural space 1.
Key Points
- Systemic antibiotic therapy is the preferred method of treatment for pleural infections and fracture-related infections.
- Local application of antimicrobials may be considered in certain cases, but this should be done using established commercial formulations and techniques.
- Direct infusion of antibiotics into body cavities is not a recommended practice and may not be effective or safe.
From the Research
Antibiotic Infusion into Body Cavities
- Antibiotics can penetrate into the pleural space, with studies showing that certain antibiotics reach pleural fluid levels equivalent to or higher than blood levels 2, 3.
- The penetration of antibiotics into the pleural space is important for the treatment of pleural infections, such as empyema 4, 5.
- Some studies have investigated the use of intrapleural fibrinolytic therapy, which involves injecting fibrinolytics directly into the pleural space to help break down fibrin and improve drainage 5, 6.
- However, there is limited evidence on the direct infusion of antibiotics into other body cavities, such as joints.
- The treatment of pleural infections typically involves a combination of antibiotic therapy and drainage of the pleural space, with surgical intervention reserved for cases where medical therapy fails 4, 5, 6.
- The choice of antibiotic and treatment approach may depend on the underlying cause of the infection and the patient's individual characteristics 2, 5.