Concentrations of azithromycin in tonsilar and/or adenoid tissue from paediatric patients
B P Vaudaux1, J Cherpillod, P Dayer
1Department of Paediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Insights
Azithromycin concentrations in tonsil and adenoid tissue remain high for up to 8 days after a 3-day course. This supports azithromycin
Area of Science:
- Pharmacokinetics and Drug Metabolism
- Pediatric Infectious Diseases
- Otolaryngology
Background:
- Upper respiratory tract infections (URTIs) are common in children.
- Antibiotic resistance necessitates optimized dosing strategies.
- Understanding drug distribution in target tissues is crucial for effective treatment.
Purpose of the Study:
- To determine azithromycin concentrations in pediatric tonsillar and adenoid tissues.
- To compare tissue concentrations with serum levels.
- To evaluate the duration of azithromycin presence in these tissues after a short-course regimen.
Main Methods:
- Children (1.6-7.5 years) received a 3-day course of oral azithromycin (10 mg/kg/day).
- Tonsil/adenoid tissue samples were collected during surgery at 1, 2, 4, and 8 days post-treatment.
- Serum samples were collected concurrently from a subset of patients.
Main Results:
- Mean azithromycin tissue concentrations were significantly higher than serum levels.
- Tissue concentrations remained elevated up to 8 days after the final dose.
- High tissue:serum concentration ratios (up to 956:1) were observed.
Conclusions:
- A 3-day oral azithromycin regimen leads to sustained high concentrations in tonsillar and adenoid tissues.
- These findings support the efficacy of short-course azithromycin for pediatric URTIs.
- No adverse events were reported, indicating a favorable safety profile.
Abstract:
Azithromycin levels in tonsillar and/or adenoid tissue were determined in children (1.6-7.5 years old) who were scheduled for surgical removal of their tonsils and/or adenoids. The children received azithromycin oral suspension 10 mg/kg once daily for 3 days. Tissue samples were obtained during surgery 1 (n = 4), 2 (n = 5), 4 (n = 6), or 8 (n = 5) days after the last dose of azithromycin. Serum samples were also obtained from four children in each of these groups at the time of surgery. Mean tissue concentrations of azithromycin were 10.33 +/- 3.01, 7.21 +/- 4.04, 9.30 +/- 3.74 and 1.49 +/- 0.48 mg/kg, respectively, 1, 2, 4 and 8 days after the last dose. At the corresponding times, serum concentrations were markedly lower: 47.25 +/- 19. 19, 14.00 +/- 8.45, 8.00 +/- 2.16 and < 4 micrograms/L, respectively. The mean tissue:serum concentration ratios were, 227 +/- 54, 547 +/- 184 and 956 +/- 355, respectively, 1, 2 and 4 days after treatment. No adverse events attributable to azithromycin were observed in any of the 23 children who had received at least one dose of azithromycin. The study shows that levels of azithromycin in tonsillar and adenoid tissue were consistently higher than in serum and remained elevated up to 8 days after the end of dosing, supporting the use of a short-course (3-day), once-daily regimen of azithromycin in the treatment of upper respiratory tract infections.
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