title: [Ampicillin and sulbactam concentrations in the irradiated mandible after oral squamous cell cancer].
abstract: BACKGROUND
  Radiation therapy of the oral and maxillo-facial region increases the risk of an infected osteoradionecrosis (IORN) which is a severe complication. Therefore, perioperative antibiotics for the prophylaxis of ORN is a standard in clinical oncology. The combination therapy of ampicillin and sulbactam (Unacid) promises a good therapeutic and prophylactic outcome.
  
  
  METHODS
  We compared the concentration of Unacid in bone and blood specimens of 22 irradiated patients. All patients were irradiated with 39.6 Gy prior to surgery. The specimens were obtained during the operation 3 weeks after the end of the radiation therapy.
  
  
  RESULTS
  The concentration of ampicillin/sulbactam in the blood was 124.9/64.5 microg/ml. The bone specimens showed a concentration of ampicillin/sulbactam of 5.54/1.21 microg/g. The concentration of the antibiotic in the bone was three to four times lower than in non-irradiated patients. Nevertheless, this concentration exceeds the minimum inhibitory concentration for bacteria in the oral cavity such as streptcoccae (MHK90<0.25 microg/ml) or staphylococcae (MHK90=0.12-2.0 microg/ml).
  
  
  CONCLUSIONS
  The results of this study suggest, that Unacid is an effective antibiotic in the prophylaxis of ORN in irradiated patients with head and neck tumors.
authors.affiliation: Praxis für Mund-, Kiefer- und Gesichtschirurgie.
authors.forename: H
authors.initials: H
authors.lastname: Heibel
authors.forename: M
authors.initials: M
authors.lastname: Scheer
authors.forename: T
authors.initials: T
authors.lastname: Reuther
authors.forename: M
authors.initials: M
authors.lastname: Hahn
authors.forename: R
authors.initials: R
authors.lastname: Trittler
authors.forename: H
authors.initials: H
authors.lastname: Egle
authors.forename: K
authors.initials: K
authors.lastname: Kümmerer
authors.forename: A C
authors.initials: AC
authors.lastname: Kübler
mesh_terms: D000328:Adult; D000368:Aged; D000667:Ampicillin / Q000008:administration & dosage / Q000493:pharmacokinetics; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000378:metabolism / Q000528:radiation effects / Q000601:surgery; D008339:Mandibular Neoplasms / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D020360:Neoadjuvant Therapy; D010025:Osteoradionecrosis / Q000097:blood / Q000517:prevention & control*; D013407:Sulbactam / Q000008:administration & dosage / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; C035444:sultamicillin; D000667:Ampicillin; D013407:Sulbactam