Antimicrobial agents in the treatment of bacterial meningitis

Bacterial meningitis: An update review

“…Table 6 summarizes the recommended antimicrobial therapy for each pathogen-specific acute meningitis. The blood brain barrier (BBB) characteristics and the physicochemical properties of the antimicrobial agent such as logP and pKa are considered the most critical factors affecting adequate CSF concentrations (Sinner and Tunkel, 2004;Nau et al, 2010).…”

“…In contrast to hydrophilic agents, such as β-lactams and vancomycin, these depend on the opening of tight junctions for entry and as a result have poor penetration and delayed onset of peak CSF concentrations (Lutsar et al, 1998;Chowdhury and Tunkel, 2000;Sinner and Tunkel, 2004). …”

“…Fluoroquinolones and rifampin have low molecular weights and simple structures, which result in a better CSF penetration compared with larger compounds with more complex structures, such as vancomycin (Lutsar et al, 1998;Chowdhury and Tunkel, 2000;Sinner and Tunkel, 2004).…”

“…In bacterial meningitis, the pH of CSF is lower than that of plasma, so drugs such as β-lactam antibiotics which are weak acids and highly ionized in the physiologic pH of plasma have poor penetration into the CSF and tend to pass from the CSF into the plasma instead of in the reverse direction (Lutsar et al, 1998;Chowdhury and Tunkel, 2000;Sinner and Tunkel, 2004).…”

“…Only unbound fractions of antimicrobials enter the CSF; a high degree of protein binding in the binding in the serum (for example, with ceftriaxone) limits the degree of CSF penetration (Lutsar et al, 1998;Chowdhury and Tunkel, 2000;Sinner and Tunkel, 2004).…”