Antimicrobial use in central nervous system infections

Abstract

Purpose of review Central nervous system (CNS) infections are associated with high rates of morbidity and mortality. The purpose of this review is to summarize current antimicrobial therapies, as well as, updates in the management of community-acquired meningitis and healthcare-associated meningitis and ventriculitis. Recent findings Due to the increasing rates of multidrug resistant and extensively-drug resistant organisms, available antimicrobials are limited. Novel treatment options include newer systemic antimicrobials and antimicrobials that have previously limited data in the management of CNS infections. Although limited by retrospective data, intrathecal (IT) and intraventricular (IVT) routes of administration offer the opportunity for antimicrobials that conventionally have minimal cerebrospinal fluid (CSF) penetration to achieve high CSF concentrations while minimizing systemic exposure. Summary Updates in the use of systemic, IT, and IVT antimicrobials offer promise as therapeutic options for CNS infections. Additional pharmacokinetic and prospective data are needed to confirm these findings.

Intraventricular or intrathecal polymyxin B for treatment of post-neurosurgical intracranial infection caused by carbapenem-resistant gram-negative bacteria: a 8-year retrospective study

“…Several in vitro and clinical studies have suggested the clinical benefits of adopting polymyxin–drug combination therapy, especially polymyxin plus meropenem, with synergistic killing against MDR/XDR gram-negative bacteria [ 36 – 39 ]. Although meropenem is recommended as the main empirical treatment for healthcare-associated ventriculitis and meningitis against gram-negative bacteria [ 40 ], resistance may lead to delayed treatment effectiveness and adverse outcomes. This study found no beneficial results for the combination of polymyxin B and carbapenems, even when carbapenem therapy was optimized, such as increasing the dose and extending the infusion.…”

Consenso de la Sociedad Chilena de Infectología para el manejo de episodios de neutropenia febril en adultos y niños con cáncer

“…Los factores epidemiológicos, biomarcadores, serologías y las profilaxis recibidas son de gran utilidad para orientar la terapia empírica 162 . En adultos IS con sospecha de meningitis la terapia antimicrobiana empírica debe ser dirigida contra L. monocytogenes con ampicilina más cobertura estándar para S. pneumoniae y BGN que incluya P. aeruginosa con una cefalosporina de 4º generación como cefepime o un carbapenémico 163 . En niños, la terapia antimicrobiana debe ser de amplio espectro, usualmente basados en β-lactámicos, con cefalosporinas de tercera generación más ampicilina (que adiciona cobertura para L. monocytogenes), con o sin vancomicina, de acuerdo a la epidemiología de la resistencia in vitro de S. pneumoniae en la comunidad 107 .…”

Clinical Experience with Off-Label Intrathecal Administration of Selected Antibiotics in Adults: An Overview with Pharmacometric Considerations

“…For several antibiotics, IT use has been reviewed [ 8 , 9 , 10 ]. The range of doses administered intrathecally is quite broad.…”