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Abstract：
BACKGROUND: 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.
OBJECTIVE: 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.
METHODS: 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).
RESULTS: The highest antibiotic levels against Staphylococcus aureus reach 8.3×MIC, against Moraxella catarrhalis 33.2×MIC, against Haemophilus influenzae 31.2×MIC, and against Streptococcus pneumoniae 46.2×MIC. The macrolide antibiotics reach higher levels in the middle ear than in plasma.
CONCLUSIONS: 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.
OBJECTIVE: 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.
METHODS: 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).
RESULTS: The highest antibiotic levels against Staphylococcus aureus reach 8.3×MIC, against Moraxella catarrhalis 33.2×MIC, against Haemophilus influenzae 31.2×MIC, and against Streptococcus pneumoniae 46.2×MIC. The macrolide antibiotics reach higher levels in the middle ear than in plasma.
CONCLUSIONS: 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.
摘要：
背景：中耳的感染性疾病是全球发病率和死亡率的常见且重要的原因。经常使用全身抗生素，但它们的有效性将取决于中耳是否达到足够的抗生素浓度;这在生物膜感染如渗出性中耳炎（OME）中尤其重要，有效治疗通常需要高抗生素浓度。
目的：这篇综述研究了口服中耳可以达到的抗生素水平，作为指导临床和未来研究合理选择抗生素的手段，并确定是否达到足以根除生物膜的水平。
方法：对口服给药后血浆和中耳中抗生素水平的研究进行了文献检索。将这些水平与欧洲抗菌药物敏感性测试委员会(EUCAST)提供的最低抑制浓度(MIC)进行比较,以确定抗生素剂量是否达到足以抑制浮游细菌的水平。然后将中耳浓度计算为MIC的倍数,以确定浓度是否达到生物膜根除浓度(通常高达1000XMIC)。
结果：对金黄色葡萄球菌的最高抗生素浓度达到8.3×MIC，对卡他莫拉菌33.2×MIC，对流感嗜血杆菌31.2×MIC，对肺炎链球菌的MIC为46.2×。大环内酯类抗生素在中耳比在血浆中达到更高的水平。
结论：口服抗生素达到中耳MIC以上的水平。然而,它们不会达到可能根除生物膜的水平。
目的：这篇综述研究了口服中耳可以达到的抗生素水平，作为指导临床和未来研究合理选择抗生素的手段，并确定是否达到足以根除生物膜的水平。
方法：对口服给药后血浆和中耳中抗生素水平的研究进行了文献检索。将这些水平与欧洲抗菌药物敏感性测试委员会(EUCAST)提供的最低抑制浓度(MIC)进行比较,以确定抗生素剂量是否达到足以抑制浮游细菌的水平。然后将中耳浓度计算为MIC的倍数,以确定浓度是否达到生物膜根除浓度(通常高达1000XMIC)。
结果：对金黄色葡萄球菌的最高抗生素浓度达到8.3×MIC，对卡他莫拉菌33.2×MIC，对流感嗜血杆菌31.2×MIC，对肺炎链球菌的MIC为46.2×。大环内酯类抗生素在中耳比在血浆中达到更高的水平。
结论：口服抗生素达到中耳MIC以上的水平。然而,它们不会达到可能根除生物膜的水平。
