Aminoglycoside Therapy of Gram-Negative Bacillary Meningitis

Kaiser, Allen B.; McGee, Zell A.

doi:10.1056/nejm197512112932401

Cited by 247 publications

(108 citation statements)

References 18 publications

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“…Unsuspected ventriculitis might be a source of persistent infection and therapeutic failure in the management of meningitis [8,9]. Hydrocephalus after cerebral abscess has been documented in some of the case reports in the literature [1,10,11].…”

Section: Resultsmentioning

confidence: 99%

Disproportionate correlation between imaging and outcome in an infant with cerebral abscess

Seddighi¹,

Seddighi²

2010

Open Medicine

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AbstractBrain abscesses represent organized foci of suppuration within the parenchyma. In this paper, we describe the case of a 3-month old girl with a large, complicated cerebral abscess. In addition, the course of treatment is presented. The patient’s recovery was excellent. The follow-up MRI showed only subtle porencephalic changes as the only parenchymal sequels, which may have been due to central nervous system (CNS) plasticity in infants.

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Section: Resultsmentioning

confidence: 99%

Disproportionate correlation between imaging and outcome in an infant with cerebral abscess

Seddighi¹,

Seddighi²

2010

Open Medicine

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“…El efecto bactericida no es tiempodependiente en los aminoglucósidos y sólo es necesario alcanzar transitoriamente estas concentraciones elevadas. La aplicación de una dosis ventricular de 10 mg de gentamicina ha permitido alcanzar concentraciones máximas de 80 µg/mL y dosis de 2,5 mg han estado asociadas a concentraciones máximas entre 10 a 130 µg/mL 30,41 . La dosis intraventricular recomendada de gentamicina es de 2 a 5 mg por día.…”

Section: Aspectos Farmacocinéticos Y Farmacodinámicosunclassified

“…Diferentes series de casos han demostrado la eficacia terapéutica de gentamicina o amikacina intratecal para el tratamiento de infecciones por agentes susceptibles y la seguridad y baja toxicidad de este antimicrobiano [40][41][42][43][44][45] . A pesar de que el único estudio randomizado disponible para este antimicrobiano (desarrollado con lactantes) no logró demostrar un efecto positivo para gentamicina, la literatura y evidencia respalda mayoritariamente su uso, debido a los sesgos descritos en el trabajo original (ver más adelante) [46][47][48][49] .…”

Section: Aspectos Farmacocinéticos Y Farmacodinámicosunclassified

“…En contraste, su concentración es notoriamente menor cuando el compuesto se aplica por vía intralumbar. Por ejemplo se ha señala-do que la concentración promedio en ventrí-culos alcanza un rango de 0,0 a 2,1 µg/mL con la administración intralumbar versus cifras de 12 a 40 µg/mL con la administración intraventricular directa de gentamicina 41 .…”

Section: Variaciones En La Concentración Local De Antimicrobianos En unclassified

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Antibióticos intratecales en pacientes adultos

2003

Rev. chil. infectol.

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IntroducciónLos antimicrobianos administrados por vía intratecal son necesarios en algunas infecciones del sistema nervioso central (SNC) para proveer, en un medio carente de mecanismos fagocíticos, concentraciones bactericidas de compuestos que tienen una baja penetración por la barrera hematoencefálica.La administración intratecal considera la administración intralumbar o intraventricular de medicamentos y no reemplaza la terapia sistémica para controlar la infección fuera del SNC.Los compuestos intratecales más utilizados corresponden a aminoglucósidos y vancomicina debido a la existencia y emergencia de infecciones asociadas a bacilos Gram negativos o cocáceas Gram positivas resistentes. Estos procesos incluyen meningitis o ventriculitis, en general de carácter nosocomial y asociadas a procedimientos neuroquirúrgicos y/o derivaciones ventriculares externas o internas. Las intervenciones quirúrgicas para efectuar un drenaje del LCR en pacientes con hidrocefalia hipertensiva se han expandido progresivamente en el país y las complicaciones infecciosas agregan una morbilidad o mortalidad considerable, de allí la relevancia de conocer esta forma terapéutica. Este documento trata especialmente de las ventriculitis e infecciones asociadas a drenajes ventriculares externos. Aspectos diagnósticos de las ventriculitisEl diagnóstico de ventriculitis asociada a un drenaje ventricular no ha sido estandarizado. El espectro de alternativas incluye un cultivo del Increase of ventriculitis rates associated to CNS shunts that involve multiresistant microorganisms has made relevant this route of administration due to the limited penetration of antibiotics active against multiresistant organisms through the blood brain barrier. Aminoglycosides and vancomycin are the most common antibiotics used for this purpose. In order to accomplish bactericidal activity and due to its concentration-dependent mechanism, aminoglycosides should reach concentrations 8 to 10 times above the MIC of a given Gram negative bacilli. Doses of 2 to 5 mg for gentamicin and 30 mg for amikacin every 24 h allow this purpose and has been associated to clinical cure in several reports. Vancomycin attains its bactericidal activity by a time-dependent mechanism and the best predictor of clinical efficacy is the time area under the curve (AUC) above the MIC. Doses of 20 mg every day assure an adequate temporal exposition to the drug if trough concentrations of 5 to 10 µg/ml are obtained, and have been related to clinical efficacy. Intrathecal concentrations for these antibiotics are higher and therapeutically effective when they are administered through intraventricular route than by intralumbar puncture. Intraventricular antibiotics are indicated when a patient affected by ventriculitis does not improve despite maximal-doses systemic antibiotic therapy and/or CSF remains positive for microorganisms. In order to secure efficacy, intraventricular antibiotics should be implemented with removal of the ventricular drain associated to infection. Experience with quinu...

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“…They are mainly used for the pharmacological evaluation of direct actions of substances on the central nervous system (CNS) using minute dosage volumes. On the other hand, several kinds of drugs such as antibiotics [6], contrast media [12], analgesics [16] and anesthetics are actually administered intrathecally to humans for diagnosis or therapy. In addition, even drugs which have never passed the blood-brain and blood-cerebrospinal fluid barriers under the normal conditions can easily penetrate into the cerebral parenchymal tissues, when severe cerebral lesions with subsequent barrier damages have occurred.…”

Section: Animalsmentioning

confidence: 99%

Optimum Properties of Injectable Test Solutions for Intrathecal Administration to Conscious Rats.

Furuhama

Akahane-Shimoda

Kato

1997

The Journal of Veterinary Medical Science

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ABSTRACT. We devised a versatile intrathecal injection method enabling evaluation of central nervous system (CNS) toxicities in rats, and then explored appropriate physico-chemical properties for injectable test solutions at relatively large dosage volumes. In a preliminary bolus injection study, a 25-gauge needle was inserted into the subarachnoid space through the lateral aspect of the intervertebral portion between the 2nd and 3rd lumbar vertebra under light ether anesthesia. When 3% phthalocyanine blue solution, a vital dye, was injected in order to confirm its transfer to the brain tissue, the dye reached the cerebral ventricle, perivascular spaces and veins of the cerebral cortex. On the basis of these information, a fine polyethylene tube was introduced up to a level around the axis via a 20-gauge needle inserted in advance into the vertebral space by the same way. The needle was then withdrawn from the space leaving the tube filled with a test solution. After a full recovery from anesthesia, the infusion was commenced. Injection volume-versus-speed or osmolality-versus-pH relationship was assessed using solutions with various compositions, followed by monitoring mortality coupled with clinical signs. The tolerable combination of factors for the intrathecal solution without causing death was thought to be an injection volume up to 2 ml/rat with 300 mOsm/kg H 2 O, pH 3 to 7, at a injection speed of less than 0.5 ml/min, although minor clinical signs were observed. Pathological examination revealed pulmonary edema in dead animals, but no changes in surviving animals. This method applicable to conscious rats is considered to be simple and reliable, and does not require surgical operation and special equipment. The toxicological event in the intrathecal route seems to depend largely on the physico-chemical characteristics of the injectable solution. under these experimental conditions. -KEY WORDS: conscious condition, intrathecal injection, rat J. Vet. Med. Sci. 59(12): 1103-1107, 1997 ever been reported. We thus have devised an intrathecal injection method for conscious rats by combining previously stated techniques for mice [14] and rats [7,18,19], and then determined the suitable physico-chemical properties as its injectable test solutions. MATERIALS AND METHODS Animals:Male Sprague-Dawley rats aged 7 weeks with an average weight of 200-220 g were purchased from Japan S.L.C. Inc. (Hamamatsu, Shizuoka, Japan). The animals were housed 2 or 3 per wire-mesh cages in an airconditioned room (temperature, 23 ± 2°C; humidity, 55 ± 15%; light cycle, 12 hr/day) and allowed free access to commercial chow (F2, Funabashi Farm, Chiba, Japan) and tap water. Rats were acclimated to the laboratory environment for at least one week before use. All animals were treated humanely, and study protocols were in accordance with our institutional guideline for use of laboratory animals.Bolus injection procedure: Rats anesthetized with ether were placed in the prone position and an injection site was set in the lateral aspect of the...

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Aminoglycoside Therapy of Gram-Negative Bacillary Meningitis

Cited by 247 publications

References 18 publications

Disproportionate correlation between imaging and outcome in an infant with cerebral abscess

Disproportionate correlation between imaging and outcome in an infant with cerebral abscess

Antibióticos intratecales en pacientes adultos

Optimum Properties of Injectable Test Solutions for Intrathecal Administration to Conscious Rats.

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