99mTc‐Ceftizoxime: Synthesis, characterization and its use in diagnosis of diabetic foot osteomyelitis

Abstract

Introduction

The diagnosis of diabetic foot osteomyelitis is crucial and challenging for the proper management of diabetic foot. ^99mTc labelled Ceftizoxime was used as a non‐invasive diagnostic agent for diabetic foot osteomyelitis.

Methods

Ceftizoxime [CFT], a third generation cephalosporin, was used in a simple and direct method for the synthesis of ^99mTcO₄⁻ labelled infection imaging agent with stannous chloride as reducing agent. Its radiochemical purity was checked by thin Layer chromatography. Partition co‐efficient was measured with phosphate buffer and chloroform. The radiochemical complex was injected to control and infected animal model for 3 hours in‐vivo localization studied with the help of dual head gamma camera. The labelled complexes were injected to 5 patients of known type II diabetes mellitus suspected of diabetic foot osteomyelitis. All patients underwent dynamic and static ^99mTc‐MDP and ^99mTc‐CFT scans.

Results

The synthesized radio labelled complex was 98.8% pure, with hydrophilic character. When injected to animal model, at 120 minutes, 49.3% was localized in foci of infection with 3.35% in liver and excretion through kidney. Human studies were interpreted as true or false positive and true or false negative based on bone histopathology/culture and clinical follow‐up. We found that of 5 patients, 2 were true positive, 2 as true negative with no false positive or negative and 01 patient had soft tissue infection.

Conclusion

This study showed that ^99mTc‐CFT labelled complex could be used for detection of diabetic foot osteomyelitis; however, further confirmation of results with a larger patient population would be optimal.

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