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[Tonsillar diffusion of cefixime in children]
P Bégué1, N Garabédian, B Quinet
1Service de Consultation et de Pathologie infectieuse de l'Enfant, Hôpital Trousseau, Paris.
Abstract:
Cefixime was assayed by a microbiological method in the tonsils of 21 children (mean age 59 months). Tonsillectomy was performed 5 hours after a third dose of 4 mg/kg administered 12-hourly. Plasma cefixime levels were evaluated 10 hours after the second dose with a mean value of 0.84 mg/l (range: 0 to 1.35) and again after a third dose during amygdalectomy with a mean value of 1.24 mg/l (range: 0.1 to 3.9). Cefixime concentrations were 0.74 micrograms/g in the right tonsils and 0.53 micrograms/g in the left tonsils. The antibiotics could not be detected in both tonsils in 6 children and in one of the two tonsils in 11 children. The tissue penetration of cefixime in tonsils therefore was about 1 micrograms/g in those cases where cefixime was detectable. As with other beta-lactam antibiotics, this penetration is not regular, being dependent on the degree of tonsillar fibrosis inhibitin their diffusion.
Insights
Cefixime tissue penetration into children's tonsils was variable, with detectable levels averaging around 1 microgram/g. This irregular diffusion may be influenced by tonsillar fibrosis, impacting antibiotic efficacy.
Area of Science:
- Pharmacology
- Microbiology
- Otolaryngology
Context:
- Pediatric tonsillectomy procedures provide an opportunity to study antibiotic tissue penetration.
- Cefixime is a third-generation cephalosporin antibiotic commonly used for bacterial infections.
Purpose:
- To quantify cefixime concentrations in human tonsil tissue following oral administration.
- To assess the variability and factors influencing cefixime penetration into tonsils.
Summary:
- Cefixime levels were measured in tonsils of children undergoing tonsillectomy after a specific dosing regimen.
- Detectable cefixime concentrations in tonsil tissue averaged approximately 1 microgram/g.
- Antibiotic detection was inconsistent, with absence in one or both tonsils in a significant number of children.
- Tonsillar fibrosis was identified as a potential factor limiting cefixime diffusion.
Impact:
- Provides crucial data on the pharmacokinetic profile of cefixime in a relevant human tissue.
- Highlights the challenges in achieving consistent therapeutic antibiotic levels in tonsillar tissue.
- Informs clinical decisions regarding the use of cefixime for tonsillar infections and the potential need for alternative treatments.