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Azidocillin and ampicillin concentrations in middle ear effusion
Abstract:
The penetration of azidocillin and ampicillin into the middle ear effusion after oral administration was studied and compared with blood levels of the drugs. In acute otitis media one hour after a single oral dose of azidocillin (15 mg/kg) 1.56 +/- 0.44 microgram/ml of the drug was found in the effusion fluid; after 2 hours the fluid contained 3.21 +/- 0.87 microgram/ml and after 12 hours,0.84 +/- 0.13 microgram/ml. The concentrations of ampicillin were 1.15 +/- 0.23 microgram/ml after one hour, 2.17 +/- 0.46 microgram/ml after 2 hours and 1.09 +/- 0.22 microgram/ml after 8 hours following a single oral dose of 10 mg/kg. Both drugs stay longer in the middle ear secretion than in the blood. This persistence supports the administration of azidocillin twice daily in acute otitis media. In contrast, the penetration of the drugs into the middle ear effusion fluid was poor in secretory otitis media, where the levels of the drugs were significantly lower.
Insights
Azidocillin and ampicillin achieve higher concentrations in middle ear fluid than blood in acute otitis media. This prolonged presence supports twice-daily azidocillin dosing for effective treatment.
Area of Science:
- Pharmacology
- Otolaryngology
- Infectious Diseases
Background:
- Acute otitis media (AOM) and secretory otitis media (SOM) are common ear infections.
- Effective antibiotic penetration into middle ear effusion (MEE) is crucial for treatment success.
Purpose of the Study:
- To compare the penetration and persistence of azidocillin and ampicillin into middle ear effusion (MEE) following oral administration in patients with acute otitis media (AOM).
- To compare drug levels in MEE with concurrent blood levels.
- To evaluate the drug penetration in secretory otitis media (SOM).
Main Methods:
- Oral administration of azidocillin (15 mg/kg) and ampicillin (10 mg/kg) to patients with AOM.
- Sampling of middle ear effusion and blood at various time points post-administration.
- Quantification of drug concentrations using established analytical methods.
Main Results:
- Azidocillin and ampicillin concentrations in MEE were significantly higher and persisted longer than in blood after oral administration in AOM.
- Peak concentrations in MEE were observed around 2 hours post-dose for both drugs.
- Drug penetration into MEE was poor in patients with SOM, with significantly lower drug levels.
Conclusions:
- Azidocillin and ampicillin demonstrate favorable penetration and sustained levels in middle ear effusion in acute otitis media.
- The prolonged presence of these antibiotics in MEE supports their efficacy in treating AOM.
- Twice-daily dosing of azidocillin is supported by its pharmacokinetic profile in MEE.
- Antibiotic penetration is compromised in secretory otitis media, suggesting potential challenges in treatment.