Do orally administered antibiotics reach concentrations in the middle ear sufficient to eradicate planktonic and biofilm bacteria? A review. Issue 3 (March 2015)

• Record Type: Journal Article
• Authors: Belfield, Katherine; Bayston, Roger; Birchall, J.P.; Daniel, Matija
• Is Part Of: International journal of pediatric otorhinolaryngology. Volume 79:Issue 3(2015:Mar.)
• Page Start: 296
• Page End: 300
• Publication Date: 2015-03
• Subjects: Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Oto-rhino-laryngologie -- Périodiques; Pédiatrie -- Périodiques; 618.9209751
• DOI: 10.1016/j.ijporl.2015.01.003
• Languages: English
• ISSNs: 0165-5876

Abstract

<abstract abstract-type="author" id="abs0005"> <title id="sect0005">Abstract</title> <sec> <title id="sect0010">Introduction</title> <p id="spar0005">Infectious conditions of the middle ear are a common and significant cause of morbidity and mortality worldwide. Systemic antibiotics are frequently used, but their effectiveness will depend on whether an adequate antibiotic concentration is achieved in the middle ear; this is especially important in biofilm infections such as otitis media with effusion (OME), where high antibiotic concentrations are typically required for effective treatment.</p> </sec> <sec> <title id="sect0015">Objective</title> <p id="spar0035">This review examines what antibiotic levels can be reached in the middle ear with oral administration, as a means of guiding rational antibiotic choice in the clinic and future research, and to determine whether levels high enough for biofilm eradication are reached.</p> </sec> <sec> <title id="sect0020">Methods</title> <p id="spar0010">A literature search of studies measuring levels of antibiotics in the plasma and in the middle ear after oral administration was conducted. These levels were compared to the minimum inhibitory concentrations (MIC) provided by the European Committee for Antimicrobial Susceptibility Testing (EUCAST) to determine if antibiotic doses were reaching sufficient levels to inhibit planktonic bacteria. The middle ear concentrations were then calculated as a multiple of the MIC to determine if the concentrations were reaching biofilm eradication concentrations (typically up to 1000 × MIC).</p> </sec> <sec> <title id="sect0025">Results</title> <p id="spar0015">The highest antibiotic levels against <italic>Staphylococcus aureus</italic> reach 8.3 × MIC, against <italic>Moraxella catarrhalis</italic> 33.2 × MIC, against <italic>Haemophilus influenzae</italic> 31.2 × MIC, and against <italic>Streptococcus pneumoniae</italic> 46.2 × MIC. The macrolide antibiotics reach higher levels in the middle ear than in plasma.</p> </sec> <sec> <title id="sect0030">Conclusions</title> <p id="spar0020">Orally administered antibiotics reach levels above the MIC in the middle ear. However, they do not reach levels that would be likely to eradicate biofilms.</p> </sec> </abstract>