Long-standing otitis media with effusion--a convenient model for the study of antibiotic penetration to respiratory tract secretions.

In long-standing otitis media with effusion, myringotomy with aspiration of the middle ear exsudate is an established therapeutical procedure, which can be performed under carefully planned conditions. This common disease thus offers convenient advantages for the study of antibiotic concentrations in the middle ear. This is exemplified by a review of studies with erythromycin, doxycycline and cefaclor. A delayed penetration into the middle ear was demonstrated for all these antibiotics, especially for erythromycin. The elimination from the middle ear was slower than from serum, at least with erythromycin and doxycycline. With these two antibiotics, the middle ear concentrations were close to the peak serum levels, with only small fluctuations between doses during a course of treatment. With cefaclor, peak middle ear concentrations were less than 40% of peak serum levels. By using this model, data from a natural disease in humans are obtained. Since the mucosa anywhere in the respiratory tract reacts in a uniform manner to an inflammatory stimulus, results from studies on long-standing otitis media with effusion can disclose some aspects on antibiotic pharmacokinetics in respiratory tract secretions in general.