Stjernquist-Desatnik A, Samuelsson P, Walder M
Department of Oto-Rhino-laryngology, University Hospital, Lund, Sweden.
J Laryngol Otol. 1993 Apr;107(4):309-12. doi: 10.1017/s0022215100122893.
In the treatment of group A streptococcal tonsillitis, as the bacteria are located on the epithelial surface, an important determinant of outcome is the concentration of penicillin in extracellular tonsillar surface fluid. Accordingly, we investigated the concentration of penicillin in serum, and penetration to tonsillar surface fluid and saliva in nine patients with acute group A streptococcal tonsillitis and in nine healthy controls. Among the healthy subjects, despite high serum penicillin concentrations (mean, 2.04 micrograms/ml), there was no penetration to tonsillar surface fluid or to saliva, whereas erythromycin penetrated to tonsillar surface fluid in 3/6 cases. Of the nine patients with acute tonsillitis, on the first day of treatment eight manifested high concentrations of penicillin in tonsillar surface fluid (mean, 0.34 micrograms/ml--i.e. well above the minimal inhibitory concentration (MIC) for group A streptococci), but penetration to saliva was found in only two patients. On the tenth day of treatment, penicillin was not present in the saliva of any of the patients and was present in the tonsillar surface fluid of only one. The results suggest that measurable concentrations of penicillin in tonsillar surface fluid can only be obtained in the presence of inflammation with fluid exudation through the tonsillar epithelium.
在A组链球菌性扁桃体炎的治疗中，由于细菌位于上皮表面，治疗结果的一个重要决定因素是细胞外扁桃体表面液中青霉素的浓度。因此，我们研究了9例急性A组链球菌性扁桃体炎患者和9例健康对照者血清中青霉素的浓度，以及青霉素渗透至扁桃体表面液和唾液中的情况。在健康受试者中，尽管血清青霉素浓度较高（平均为2.04微克/毫升），但青霉素并未渗透至扁桃体表面液或唾液中，而红霉素在6例中有3例渗透至扁桃体表面液中。在9例急性扁桃体炎患者中，治疗第一天有8例扁桃体表面液中青霉素浓度较高（平均为0.34微克/毫升，即远高于A组链球菌的最低抑菌浓度（MIC）），但只有2例患者的唾液中有青霉素渗透。治疗第十天时，所有患者的唾液中均未检测到青霉素，只有1例患者的扁桃体表面液中有青霉素。结果表明，只有在炎症伴有通过扁桃体上皮的液体渗出时，才能在扁桃体表面液中获得可测量浓度的青霉素。
