Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-26T18:53:42.863Z Has data issue: false hasContentIssue false
  • English
  • Français

Penetration of penicillin V to tonsillar surface fluid in healthy individuals and in patients with acute tonsillitis

Published online by Cambridge University Press:  29 June 2007

A. Stjernquist-Desatnik ,
P. Samuelsson  and
M. Walder
A. Stjernquist-Desatnik*
Affiliation:
Department of Oto-Rhino-laryngology, University Hospital, Lund, Sweden
P. Samuelsson
Affiliation:
Department of Oto-Rhino-laryngology, University Hospital, Lund, Sweden
M. Walder
Affiliation:
Department of Medical Microbiology, Malmö General Hospital, Malmö, Sweden.
*
Anna Stjernquist-Desatnik, M.D., Ph.D., Department of Oto-Rhino-Laryngology, University Hospital, S-221 85 Lund, Sweden
Get access Rights & Permissions [Opens in a new window]

Abstract

In the treatment of group A streptococcal tonsillitis, as the bacteria are located on the epithelial surface, an important determinant of outcome is the concentration of penicillin in extracellular tonsillar surface fluid. Accordingly, we investigated the concentration of penicillin in serum, and penetration to tonsillar surface fluid and saliva in nine patients with acute group A streptococcal tonsillitis and in nine healthy controls.

Among the healthy subjects, despite high serum penicillin concentrations (mean, 2.04) (ig/ml), there was no penetration to tonsillar surface fluid or to saliva, whereas erythromycin penetrated to tonsillar surface fluid in 3/6 cases.

Of the nine patients with acute tonsillitis, on the first day of treatment eight manifested high concentrations of penicillin in tonsillar surface fluid (mean, 0.34 (ig/ml—i.e. well above the minimal inhibitory concentration (MIC) for group A streptococci), but penetration to saliva was found in only two patients. On the tenth day of treatment, penicillin was not present in the saliva of any of the patients and was present in the tonsillar surface fluid of only one. The results suggest that measurable concentrations of penicillin in tonsillar surface fluid can only be obtained in the presence of inflammation with fluid exudation through the tonsillar epithelium.

Keywords

TonsillitisPenicillin, concentrationStreptococcus
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 107 , Issue 4 , April 1993 , pp. 309 - 312
Copyright
Copyright © JLO (1984) Limited 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Brook, I. (1985) Role of beta-lactamase producing bacteria in the failure of penicillin to eradicate group A streptococci. Pediatric Infectious Disease Journal 4: 491–495.CrossRefGoogle ScholarPubMed
Engquist, S., Lundberg, C. (1987) Bakteriers topografiska relation till slemhinnestrukturer vid slemhinneinfektioner (in Swedish). Svensk Otolaryngologisk Forenings Forhandlingar 2.Google Scholar
Holm, S. E., Ekedahl, C. (1982) Comparative study of the penetration of penicillin V and cefadroxil into tonsils in man. Journal of Antimicrobial Chemotherapy 10: (Suppl. B), 137–142.CrossRefGoogle ScholarPubMed
Ingvarsson, L., Kamme, C, Lundgren, K. (1980) Concentration of penicillin V in serum and middle ear exudate during treatment of acute otitis media. Annals of Otology, Rhinology and Laryngology 89: (Suppl. 68), 59–61.CrossRefGoogle ScholarPubMed
Kaplan, E. L., Gastandjy, A., Huwe, B. (1981) The role of the carrier in treatment failures after antibiotic therapy for group A streptococci in the upper respiratory tract. Journal of Laboratory and Clinical Medicine 98: 326–335.Google Scholar
Kim, K. S., Kaplan, E. L. (1985) Association of penicillin tolerance with failure to eradicate group A streptococci from patients with pharyngitis. Journal of Pediatrics 107: 681–684.CrossRefGoogle Scholar
Nissinen, A., Kontinen, S., Huovinen, P., Järvinen, H., Oinonen, S., Liimatainen, O., Katila, M.-L., Herva, E. (1991) Erythromycin resistance in group A streptococcus in Finland 1990. II Scandinavian Meeting of Bacteriology, Turku, Finland, Abstract p. 14.Google Scholar
Persico, M., Podoshin, L., Fradis, M., Grushka, M, Golan, D., Foltin, V., Wellisch, G., Cahana, Z., Kolin, A., Winter, S. (1985) Recurrent acute otitis media—prophylactic penicillin treatment: a prospective study. Part I. International Journal of Pediatric Otorhinolaryngology 10: 37–46.CrossRefGoogle ScholarPubMed
Roos, K., Holm, S. E., Ekedahl, C. (1985) Treatment failure in acute streptococcal tonsillitis in children over the age of 10 and in adults. Scandinavian Journal of Infectious Diseases 17: 357–365.CrossRefGoogle ScholarPubMed
Roos, K., Grahn, E., Holm, S. E. (1986a) Evaluation of betalactamase activity and microbial interference in treatment failures of acute streptococcal tonsillitis. Scandinavian Journal of Infectious Diseases 18: 313–319.CrossRefGoogle ScholarPubMed
Roos, K., Grahn, E., Ekedahl, C., Holm, S. E. (1986b) Pharmacokinetics of phenoxymethylpenicillin in tonsils. Scandinavian Journal of Infectious Diseases 18: 125–130.CrossRefGoogle ScholarPubMed
Schwarz, R. H., Wientzen, R. L. Jr. , Pedreira, F., Feroli, E. J., Mella, G. W., Guandolo, V. L. (1981) Penicillin V for group A streptococcal pharyngotonsillitis. A randomized trial of seven vs 10* days' therapy. JAMA 246: 1790–1795.CrossRefGoogle Scholar
Stjernquist-Desatnik, A., Orrling, A., Schalen, C., Kamme, C. (1991a) Penicillin tolerance in group A streptococci and treatment failure in streptococcal tonsillitis. Ada Oto-Laryngologica (Stockholm), (Suppl) 492: 68–71.Google Scholar
Stjernquist-Desatnik, A., Prellner, K., Schalén, C. (1991b) High recovery of Haemophilus influenzae and group A streptococci in recurrent tonsillar infection or hypertrophy as compared with normal tonsils. Journal of Laryngology and Otology 105: 439–441.CrossRefGoogle ScholarPubMed
Stromberg, A., Friberg, U., Cars, O. (1987) Concentrations of phenoxymethylpenicillin and cefadroxil in tonsillar tissue and tonsillar surface fluid. European Journal of Clinical Microbiology 6: 525–529.CrossRefGoogle ScholarPubMed
Sundberg, L., Edén, T., Ernstson, S. (1981) Penetration of erythromycin in Waldeyer's ring—tonsil tissue. Ada Oto-Laryngologica (Stockholm), (Suppl) 384: 10–17.CrossRefGoogle Scholar
Wannamaker, L. W. (1972) Perplexity and precision in the diagnosis of streptococcal pharyngitis. American Journal of Diseases of Children 124: 352–358.Google ScholarPubMed