Recurrent or chronic adenotonsillar infections mainly affect children and frequently involve otherwise healthy subjects. Therefore, having excluded systemic immunological deficiencies, this disease may be due to a local dysfunction of the epithelial structures at either the rhino or oropharyngeal level. The aim of the present investigation was to analyze structural and immunological aspects of tonsils and adenoids in subjects who underwent adenotonsillectomy because of recurrent inflammatory episodes with fever. Histological studies and analyses of the cytokine patterns were carried out in palatine tonsils and adenoid samples from 105 patients who underwent adenoidectomy and bilateral extracapsular tonsillectomy for chronic inflammatory hypertrophy of these organs; 46 of the 105 cases examined presented hyperkeratosis of the crypt epithelium; in the remaining 59, the epithelium was hyperplastic with no signs of keratosis. Scanning electron microscopy revealed a continuous epithelial surface of polygon-shaped flattened cells with fissures towards the cryptic depressions. Titration of interleukin-1␤ and tumor necrosis factor alpha in serum and tissues demonstrated higher concentrations in the adenotonsillar specimens, whereas the rise in interleukin-6 was more modest.There are still some controversies among specialists in internal medicine, pediatrics, and otorhinolaryngologists concerning the diagnostic and therapeutic approach to recurrent and chronic inflammatory conditions of adenoids and tonsils in children.Over the last few decades, immunobiological techniques have allowed the identification of tonsillar cells responsible for inflammatory immune reactions (2, 5). Recurrent or chronic adenotonsillar infections mainly affect children and frequently involve otherwise healthy subjects. Therefore, having excluded systemic immunological deficiencies, this disease may be due to a local dysfunction of the epithelial structures, at either the rhino or oropharyngeal level.Several authors (4, 6, 8) have tried to explain why and how a modification in the balance between the local immunological function of the host and the infectious agents would lead to a clinical process characterized by recurrent inflammatory events.The complex histological configuration of the parenchyma is fundamental for the uptake and presentation of antigens to the subepithelial immunocompetent cells. This allows the whole organ to act as a functional unit and hence to play an important role in fighting microorganisms. It may therefore be hypothesized that persistent local inflammatory reactions in adenotonsillitis may, with time, lead to histomorphological changes and functional deficiencies in defense barriers (3).The aim of the present investigation was to analyze structural and immunological aspects of tonsils and adenoids in subjects who underwent adenotonsillectomy because of recurrent inflammatory episodes with fever. MATERIALS AND METHODS Patients.We selected 105 children affected by chronic inflammatory hypertrophy of palatine tonsils an...

The pharmacokinetics and bacteriological effect of ceftazidime were evaluated in rabbits experimentally infected with Streptococcus pneumoniae, Haemophilus irfluenzae type b, and Escherichia coli Kl. The mean penetration of ceftazidime into cerebrospinal fluid after single-dose or constant-infusion administration ranged from 7.8 to 14.9%0. The median cerebrospinal fluid bactericidal titers were 1:64 against S. pneumoniae and H. influenzae and 1:128 against E. coli. The bacterial colony counts in cerebrospinal fluid were reduced by 58% to 100%0 (-2.3 to -3.9 log10 CFU/ml) in 3 h and by 100% (-3.2 to -5.1 log10 CFU/ml) in 9 h of constant infusion, whereas in untreated infected animals, bacterial counts increased from +1.4 to +2.1 log1o CFU/ml in 9 h. These data on ceftazidime compare favorably with those on penicillin, chloramphenicol, netilmicin, and moxalactam in this experimental meningitis model.Ceftazidime is a new 3-lactam antibiotic that has potential for therapeutic use in bacterial meningitis. The agent has in vitro activity against gram-negative bacilli comparable to that of other new cephalosporin derivatives but is more active against Pseudomonas aeruginosa (9, 13). It is also active against 1-lactamasepositive and -negative Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis (3,5), the principal pathogens of meningitis of infancy and early childhood. In addition, this new cephalosporin derivative is not metabolized in vivo (10,15) and has low protein-binding ability (10), and tubular secretion is unaffected by probenecid (7). These properties are also found with moxalactam (2, 7, 16), which achieves excellent cerebrospinal fluid (CSF) concentrations through inflamed meninges (4, 11, 12).The present study was designed to determine the pharmacokinetics of ceftazidime in serum and CSF of healthy young rabbits and those with experimental meningitis due to H. influenzae type b, S. pneumoniae, and Escherichia coli. The results of this investigation are compared with those from previous studies in which conventional antibiotic therapy and moxalactam were evaluated in experimental meningitis caused by the same pathogens (8,11,12 MATERIALS AND METHODSTest organisms. We used S. pneumoniae type 6, H. influenzae type b (,B-lactamase positive), and E. coli Kl, obtained from CSF of patients with meningitis. These organisms were grown in Mueller-Hinton broth containing 50 ,ug of calcium per ml, 25 ,ug of magnesium per ml, and 1% hemolysed horse blood for S. pneumoniae, brain heart infusion broth with Levinthal supplement for H. influenzae, and Mueller-Hinton broth for E. coli. After centrifugation, each organism was suspended in phosphate-buffered saline (0.01 M P04-0.15 M NaCl, pH 7.4) to a concentration of 6 to 8 log10o CFU/ml for inoculation. The minimal bactericidal concentrations of ceftazidime against S. pneumoniae, H. influenza, and E. coli were 0.125, 0.125, and 0.25 ,ug/ml, respectively.Rabbit model. New Zealand white male rabbits, weighing 2 to 3 kg each, were prepared by t...

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Ceftibuten and azithromycin allow simple treatment schedules (i.e. once daily administration, short duration of treatment). The somewhat higher eradication rate recorded after ceftibuten administration is consistent with the overall superior bactericidal activity of beta-lactams compared with macrolides vs. GABHS in vitro.