Concentration of penicillin and tetracycline in maxillary sinus secretion after a single dose

Effects of drainage in the treatment of acute maxillary sinusitis

24 patients with maxillary sinusitis were studied with regard to the effect of therapy. 8 of the patients were treated with a single dose of antibiotics and repeated antral aspirations at close intervals. 16 other patients were treated with repeated aspirations only. In the first group, 'cure', in the sense of freedom from retained secretion, was achieved after 3-5 aspirations within 2-10 hours. In the second group, changes in the proteolytic activity and the concentrations of albumin, IgG, IgM and IgA were followed. In purulent secretions the proteolytic activity was high and the concentrations of proteins were low, whereas the proteolytic activity of the serous secretions was low and the concentrations of proteins of the same magnitude as that of the patient serum. As a result of drainage the proteolytic activity was significantly reduced and the concentrations of proteins significantly increased.

A pharmacokinetic study of bacampicillin in patients with chronic maxillary sinusitis

The penetration of ampicillin into sinus mucosa and secretion after oral bacampicillin was studied in 30 patients subjected to radical maxillary sinus surgery. Bacampicillin in a dose of 1200 mg was administered orally before the operation and the concentrations in serum, sinus mucosa and secretion were assayed. The mean serum concentration (+/- SEM) reached its maximum of 13.4 +/- 1.2 micrograms/ml in about one hour. The mean concentrations in the secretion and mucosa after two to five hours were 1.6 +/- 0.5 micrograms/ml and 1.6 +/- 0.4 micrograms/ml respectively. The clinical course of the patients was mostly uneventful. Adverse effects probably caused by the drug were found in two cases.

The antibacterial effect of antibiotics in treatment of maxillary sinusitis

The antibacterial effect of antibiotic treatment in maxillary sinusitis has been assessed by studying the elimination of bacteria from the maxillary sinus during treatment with penicillin and tetracycline. As adequate antibiotic concentrations are the prerequisite for maximal antibacterial effect, the antibiotic concentrations were controlled. The antibiotic concentrations were determined in maxillary sinus secretions and/or mucosas of 113 patients with maxillary sinusitis, treated with single or repeated doses of penicillin or tetracycline, or the two antibiotics in combination. In 30 patients treated with either penicillin or tetracycline, the bacterial growth in sinus secretion was controlled before and after treatment. It was established that ordinary clinical doses of penicillin and tetracycline may, although not invariably, result in antibiotic concentrations in sinus secretion and sinus mucosa than can be regarded as adequate for treatment, i.e. for penicillin greater than or equal to 0.25 mug/ml and for tetracycline greater than or equal to 1.0 mug/ml. The necessity of achieving adequate antibiotic concentrations in sinus secretion and sinus mucosa to ensure therapeutic success was demonstrated. Thus, bacterial growth remained in the secretions of most maxillary sinuses when the concentrations of penicillin or tetracycline in the secretions were not regarded as adequate for treatment. In contrast, the bacteria were exterminated in most cases where concentrations were regarded as adequate.

Evaluation of the antibiotic effect of treatment of maxillary sinusitis

As the effect of antibiotic treatment of maxillary sinusitis has been questioned, the elimination of bacteria from sinus secretions was studied during antibiotic treatment. Penicillin V, azidocillin, tetracycline or doxycycline was administered to 54 patients with maxillary sinusitis. Samples of sinus secretion were aspirated both before treatment and 2-3 days after the onset of treatment. When the antibiotic concentration was below the upper limit of MIC for sensitivity group 1, bacterial growth was present in practically all samples. When the antibiotic concentration equalled or was above this limit, there was no bacterial growth in about half of the samples. A prerequisite for antibiotic effect--elimination of bacteria--is that the antibiotic concentration is well above the MIC of the bacteria at the site of infection. The choice between bactericidal or bacteriostatic antibiotics appeared unimportant. Bacterial survival in the maxillary sinus despite a high antibiotic concentration in the sinus illustrates that MIC values determined in the laboratory do not always mirror the sensitivity of bacteria to antibiotics in vivo.

Erythromycin stearate in acute maxillary sinusitis

76 patients with acute maxillary sinusitis were treated with oral erythromycin stearate (500 mg twice or 3 times a day for 10 days). The mean concentration of erythromycin in the sinus secretion after 3-5 days' treatment was 0.6 mug/ml with the lower dosage and 1.3 mug/ml with the higher. The concentration of erythromycin in the sinus secretion was, on the average, 10-20 times higher than the minimum inhibitory concentration (MIC) for group A streptococci and pneumococci, and reached MIC values for 15-30% of 100 examined strains of Haemophilus influenzae. 81% of the patients given the smaller and 94% of those given the larger dose improved or recovered. Radiological improvement was demonstrated in both groups. The infections with H. influenzae tended to respond somewhat less to the treatment than those with pneumococci. Comparisons of the roentgen findings and the findings at aspiration showed good agreement. An extra projection taken with the patient recumbent and the affected side downwards gave no information above that obtained from the routine projections. The large dose caused side effects more often (in 17/41 patients) than the smaller one (4/35 patients). In 10 patients treatment was discontinued because of side effects; 8 of them had received the larger dose.

Penetration of azidocillin into the secretion and tissues in chronic maxillary sinusitis and tonsillitis

The penetration of azidocillin into the sinus mucosa and secretion as well as into tonsils and adenoids was studied. Altogehter 73 patients were included and they were arranged in four groups according to age, diagnosis and drug dose. The average azidocillin concentration was satisfactory and predictable in all tissues and well over the MIC for most upper respiratory tract pathogens studied. In the maxillary antrum secretion the values were much lower and in many cases under the MIC for hemophilus. This is thought to depend upon the drug's being bound to proteins in the secretions. The clinical results were good in all cases and the contribution of the surgical operation, particularly in providing drainage for the secretion, is obvious.