Bone Concentration of Ampicillin/Sulbactam: A Pilot Study in Patients with Osteonecrosis of the Jaw

Anton Straub (), Maximilian Stapf, Markus Fischer, Andreas Vollmer, Christian Linz, Thiên-Trí Lâm, Alexander Kübler, Roman C. Brands, Oliver Scherf-Clavel and Stefan Hartmann
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Anton Straub: Department of Oral and Maxillofacial Plastic Surgery, University Hospital Wuerzburg, Pleicherwall 2, 97070 Wuerzburg, Germany
Maximilian Stapf: Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074 Wuerzburg, Germany
Markus Fischer: Department of Oral and Maxillofacial Plastic Surgery, University Hospital Wuerzburg, Pleicherwall 2, 97070 Wuerzburg, Germany
Andreas Vollmer: Department of Oral and Maxillofacial Plastic Surgery, University Hospital Wuerzburg, Pleicherwall 2, 97070 Wuerzburg, Germany
Christian Linz: Department of Oral and Maxillofacial Plastic Surgery, University Hospital Wuerzburg, Pleicherwall 2, 97070 Wuerzburg, Germany
Thiên-Trí Lâm: Institute for Hygiene and Microbiology, University of Wuerzburg, Josef-Schneider-Str. 2/E1, 97080 Wuerzburg, Germany
Alexander Kübler: Department of Oral and Maxillofacial Plastic Surgery, University Hospital Wuerzburg, Pleicherwall 2, 97070 Wuerzburg, Germany
Roman C. Brands: Department of Oral and Maxillofacial Plastic Surgery, University Hospital Wuerzburg, Pleicherwall 2, 97070 Wuerzburg, Germany
Oliver Scherf-Clavel: Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074 Wuerzburg, Germany
Stefan Hartmann: Department of Oral and Maxillofacial Plastic Surgery, University Hospital Wuerzburg, Pleicherwall 2, 97070 Wuerzburg, Germany

IJERPH, 2022, vol. 19, issue 22, 1-12

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.

Keywords: osteonecrosis of the jaw; ARONJ; MRONJ; ONJ; osteoradionecrosis; antibiotic bone concentration; jaw bone; beta-lactam; ampicillin (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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