Concentrations of phenoxymethylpenicillin and cefadroxil in tonsillar tissue and tonsillar surface fluid

  • A. Strömberg
  • U. Friberg
  • O. Cars


Thirty patients who underwent elective tonsillectomy were given phenoxymethylpenicillin (0.8g) or cefadroxil (1g) at different times before operation. The concentrations of the antibiotics were analysed in serum, tonsillar tissue, fluid from the surface of the tonsils, and mixed saliva. The concentrations in tonsillar tissue for both drugs were much lower than the corresponding serum concentrations. This apparently low tissue accessibility could be ascribed to the limited intracellular penetration of beta-lactam antibiotics. For both antibiotics the concentrations in the tonsillar surface fluid were higher than the levels in the tissue and well above the minimal inhibitory concentrations for streptococci. This was not due to antibiotics in saliva but probably a result of leakage from the interstitial fluid. Inability to reach active concentrations of phenoxymethylpenicillin or cefadroxil at the site of infection does not therefore seem to be a probable cause for relapse after treatment of streptococcal tonsillitis.


  1. 1.
    Schwartz, R. H., Wientzen, R. L., Pedreira, F., Feroli, E. J., Mella, G. W., Guandolo, V. L.: Penicillin V for group A streptococcal pharyngotonsillitis. A randomized trial of seven vs ten days' therapy. Journal of the American Medical Association 1981, 246: 17901795.Google Scholar
  2. 2.
    Gerber, M. A., Spadaccini, L. J., Wright, L. L., Deutsch, L., Kaplan, E. L.: Twice-daily penicillin in the treatment of streptococcal pharyngitis. American Journal of Diseases of Children 1985, 139: 1145–1148.PubMedGoogle Scholar
  3. 3.
    Roos, K., Grahn, E., Holm, S. E.: Evaluation of betalactamase activity and microbial interference in treatment failures of acute streptococcal tonsillitis. Scandinavian Journal of Infectious Diseases 1986, 18: 313–319.PubMedGoogle Scholar
  4. 4.
    Kim, K. S., Kaplan, E. L.: Association of penicillin tolerance with failure to eradicate group A streptococci from patients with pharyngitis. Journal of Pediatrics 1985, 107: 681–684.PubMedGoogle Scholar
  5. 5.
    Cars, O., Henning, C., Holm, S. E.: Penetration of ampicillin and dicloxacillin into tissue cage fluid in rabbits: relation to serum and tissue protein binding. Scandinavian Journal of Infectious Diseases 1981, 13: 69–74.PubMedGoogle Scholar
  6. 6.
    Cars, O., Ögren, S.: A microtechnique for the determination of antibiotics in muscle. Journal of Antimicrobial Chemotherapy 1981, 8: 39–48.PubMedGoogle Scholar
  7. 7.
    Cars, O., Ögren, S.: Antibiotic tissue concentrations: Methodological aspects and interpretation of results. Scandinavian Journal of Infectious Diseases 1985, Supplement 44: 7–15.Google Scholar
  8. 8.
    Josefsson, K., Bergan, T.: Pharmacokinetics of phenoxymethylpenicillin in volunteers. Chemotherapy 1982, 28: 241–246.PubMedCrossRefGoogle Scholar
  9. 9.
    Hampel, B., Hartmut, L., Wagner, J., Koeppe, P.: Pharmacokinetics of cefadroxil and cefaclor during an eightday dosage period. Antimicrobial Agents and Chemotherapy 1982, 22: 1061–1063.PubMedGoogle Scholar
  10. 10.
    Roos, K., Grahn, E., Ekedahl, C., Holm, S. E.: Pharmacokinetics of phenoxymethylpenicillin in tonsils. Scandinavian Journal of Infectious Diseases 1986, 18: 125–130.PubMedGoogle Scholar
  11. 11.
    Holm, S.E., Ekedahl, C.: Comparative study of the penetration of penicillin V and cefadroxil into tonsils in man. Journal of Antimicrobial Chemotherapy 1982, 10, Supplement B: 137–142.PubMedGoogle Scholar
  12. 12.
    Kaplan, J. M., McCracken, G. H., Snyder, E.: Influence of methodology upon apparent concentrations of antibiotics in tissue. Antimicrobial Agents and Chemotherapy 1973, 3: 143–146.PubMedGoogle Scholar
  13. 13.
    Ryan, D. M., Cars, O., Hoffstedt, B.: The use of antibiotic serum levels to predict concentrations in tissues. Scandinavian Journal of Infectious Diseases 1986, 18: 381–388.PubMedGoogle Scholar
  14. 14.
    Craig, W. A., Suh, B.: Protein binding and the antimicrobial effects: methods for the determination of protein binding. In: Lorain, V. (ed.): Antibiotics in laboratory medicine. Williams & Wilkins, Baltimore, 1986, p. 477–514.Google Scholar
  15. 15.
    Bernhardt, L. L.: Tissue and fluid concentrations of cefadroxil monohydrate. Journal of International Medical Research 1980, 8, Supplement: 58–63.PubMedGoogle Scholar
  16. 16.
    Persson, C. G.: Role of plasma exudation in asthmatic airways. Lancet 1986, ii: 1126–1129.CrossRefGoogle Scholar

Copyright information

© Friedr. Vieweg & Sohn Verlagsgesellschaft mbH 1987

Authors and Affiliations

  • A. Strömberg
    • 1
  • U. Friberg
    • 2
  • O. Cars
    • 1
  1. 1.Department of Infectious DiseasesUppsala UniversityUppsalaSweden
  2. 2.Department of OtorhinolaryngologyUppsala UniversityUppsalaSweden

Personalised recommendations