Abstract：
Osteonecrosis of the jaw (ONJ) occurs typically after irradiation of the head and neck area or after the intake of antiresorptive agents. Both interventions can lead to compromised bone perfusion and can ultimately result in infection and necrosis. Treatment usually consists of surgical necrosectomy and prolonged antibiotic therapy, usually through beta-lactams such as ampicillin/sulbactam. The poor blood supply in particular raises the question as to whether this form of antibiosis can achieve sufficient concentrations in the bone. Therefore, we investigated the antibiotic concentration in plasma and bone samples in a prospective study. Bone samples were collected from the necrosis core and in the vital surrounding bone. The measured concentrations in plasma for ampicillin and sulbactam were 126.3 ± 77.6 and 60.2 ± 35.0 µg/mL, respectively. In vital bone and necrotic bone samples, the ampicillin/sulbactam concentrations were 6.3 ± 7.8/1.8 ± 2.0 µg/g and 4.9 ± 7.0/1.7 ± 1.7 µg/g, respectively. These concentrations are substantially lower than described in the literature. However, the concentration seems sufficient to kill most bacteria, such as Streptococci and Staphylococci, which are mostly present in the biofilm of ONJ. We, therefore, conclude that intravenous administration of ampicillin/sulbactam remains a valuable treatment in the therapy of ONJ. Nevertheless, increasing resistance of Escherichia coli towards beta-lactam antibiotics have been reported and should be considered.
摘要：
颌骨坏死（ONJ）通常发生在头颈部区域照射后或摄入抗吸收剂后。两种干预措施均可导致骨灌注受损，并最终导致感染和坏死。治疗通常包括手术坏死切除术和长期抗生素治疗，通常通过β-内酰胺，如氨苄西林/舒巴坦。尤其是，血液供应不足提出了一个问题，即这种形式的抗生素是否可以在骨骼中达到足够的浓度。因此,我们在一项前瞻性研究中调查了血浆和骨样本中的抗生素浓度.从坏死核心和重要的周围骨中收集骨样品。氨苄西林和舒巴坦在血浆中的测量浓度为126.3±77.6和60.2±35.0µg/mL，分别。在重要的骨和坏死骨样本中，氨苄西林/舒巴坦浓度分别为6.3±7.8/1.8±2.0µg/g和4.9±7.0/1.7±1.7µg/g,分别。这些浓度显著低于文献中描述的浓度。然而,浓度似乎足以杀死大多数细菌，如链球菌和葡萄球菌，主要存在于ONJ的生物膜中。我们,因此,结论氨苄西林/舒巴坦静脉给药仍然是治疗ONJ的一种有价值的治疗方法。然而，大肠杆菌对β-内酰胺类抗生素的耐药性增加已有报道，应加以考虑。
