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Faculty of Pharmaceutical Sciences, The University of Tokyo
Brain interstitial fluid (ISF) concentrations, which regulate the
toxicodynamic effect of quinolone antimicrobial agents (quinolones) in
the central nervous system, have been determined for norfloxacin, ofloxacin, fleroxacin, and pefloxacin using a quantitative brain microdialysis technique. Steady-state brain ISF concentrations of the
quinolones were 7-30 times lower than the unbound serum concentrations
due to restricted distribution in the brain. Cerebrospinal fluid
concentrations of the quinolones were approximately twice as high as
the brain ISF concentrations, except for norfloxacin. Thus, it seems
that an active efflux transport system across the blood-brain barrier
is responsible for maintaining brain ISF concentrations lower than
unbound serum concentrations at steady-state. A good correlation was
observed for norfloxacin, ofloxacin, fleroxacin, and pefloxacin between
brain ISF concentrations and total brain concentrations. Moreover, a
relatively small difference was observed among the quinolones for the
in vitro brain slice-to-medium concentration ratio,
compared with an 11-fold difference in the in vivo
brain-to-unbound serum concentration ratio after intravenous infusion.
These results indicate that the different quinolones studied all
exhibit similar apparent binding and/or uptake by brain parenchyma,
with an average brain ISF-to-total brain concentration ratio of 0.688.
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