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Amikacin Penetration into Synovial Fluid during Treatment of Septic Arthritis

The concentration of amikacin from simultaneous synovial fluid and serum samples was measured on four separate occasions in a patient treated for Serratia marcescens septic arthritis. Synovial fluid levels were between 12.5 and 24.4 μg/ml, with concurrent serum levels of 12.1–21.0 μg/ml. Parenterally administered amikacin readily distributed into synovial fluid. Failure to eradicate the patient's Serratia septic arthritis with amikacin and daily arthrocentesis may have been a result of inactivation of the antibiotic arising from acidosis occurring in the synovial fluid.