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Guidance for Antibiotic Selection: Tissue Distribution and Target Site Concentration

Matson, Kelly L. PharmD*; Fallon, Renee M. PharmD

Infectious Diseases in Clinical Practice: July 2009 - Volume 17 - Issue 4 - p 231-238
doi: 10.1097/IPC.0b013e3181a65376
Review Articles

To be effective, antibacterials must be active against microorganism(s) and reach sufficient concentrations at the site of infection. Thus, antibacterial distribution and its subsequent tissue concentration are important determinants of antibiotic efficacy. Tissue distribution has many factors that contribute to an antibiotic reaching the target site of infection. This article reviews those factors (ie, basic biochemical and physiochemical properties of cell membranes, carrier-mediated transporters, plasma- and tissue-protein binding, blood flow, inflammation), and the role of impaired tissue distribution in therapeutic outcomes of patients with a variety of infections. Suboptimal target site concentrations may have important clinical implications in such infections, as they may help explain poor therapeutic outcomes. Therefore, we reviewed and summarized the literature for the concentrations of antibacterials as site to serum ratios, providing practical information as a guide for antibiotic selection.

From the *University Rhode Island, College of Pharmacy, Department of Pharmacy Practice, Kingston, RI; and †Maine Medical Center, Pediatrics, Portland, ME.

Reprints: Kelly L. Matson, PharmD, University Rhode Island, College of Pharmacy, Department of Pharmacy Practice, 144 Fogarty Hall, Kingston, RI 02881. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.