Intrathecal daptomycin use in a challenging case of Enterococcus faecium ventriculitis

Dhariwal, Ankush; Leff, Rachel; Allen, Mike; Cherian, Benny P

doi:10.1099/acmi.0.000230

Cited by 2 publications

(1 citation statement)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After systemic administration, daptomycin penetrates poorly into the CSF compartment, due to its low lipophilicity, significant protein binding and large molecular weight, thus resulting in insufficient concentrations to treat intracerebral infections [ 52 , 121 ]. In total, eight cases have been described in the literature with IT administration of daptomycin in the treatment of intracerebral infections due to Enterococci or Staphylococci (see Table 4 ) [ 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 ]. The IT doses administered ranged from 2.5 mg to 10 mg per dose, with the dosing frequency ranging from once per day to once per 72 h. The dose of 5 mg was used most frequently.…”

Section: Resultsmentioning

confidence: 99%

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

2023

View full text Add to dashboard Cite

Drain-associated intracerebral infections are life-threatening emergencies. Their treatment is challenging due to the limited penetration of antibiotics to the site of infection, resulting in potentially inadequate exposure. The emergence of multidrug-resistant pathogens might force the use of off-label intrathecal (IT) doses of antibiotics. We reviewed the literature on general aspects determining intrathecal dosing regimen, using pharmacometric knowledge. We summarised clinical experience with IT doses of antibiotics that are usually not used intrathecally, as well as the outcome of the cases and concentrations reached in the cerebrospinal fluid (CSF). Factors determining the IT regimen are the size of the ventricle system and the CSF drainage volume. With regard to pharmacometrics, pharmacokinetic/pharmacodynamic indices are likely similar to those in non-cerebral infections. The following number (N) of cases were described: benzylpenicillin (>50), ampicillin (1), ceftazidime (2), cephaloridine (56), ceftriaxone (1), cefotiam (1), meropenem (57), linezolid (1), tigecycline (15), rifampicin (3), levofloxacin (2), chloramphenicol (3) and daptomycin (8). Many side effects were reported for benzylpenicillin in the 1940–50s, but for the other antibiotics, when administered correctly, all side effects were minor and reversible. These data might help when choosing an IT dosing regimen in case there is no alternative option due to antimicrobial resistance.

show abstract

Section: Resultsmentioning

confidence: 99%

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

2023

View full text Add to dashboard Cite

show abstract

Treatment Options for Nosocomial Ventriculitis/Meningitis: A Case Report and Review of the Literature

Karvouniaris,

Aidoni,

Gkeka

et al. 2024

Pathogens

View full text Add to dashboard Cite

Ventriculo-meningitis or nosocomial meningitis/ventriculitis is a severe nosocomial infection that is associated with devastating neurological sequelae. The cerebrospinal fluid isolates associated with the infection can be Gram-positive or -negative, while the Enterococcus spp. is rarely identified. We report a case of a 68-year-old woman with a past medical history of insulin-dependent diabetes mellitus, hypertension, and coronary artery disease. She was admitted to the intensive care unit following a scheduled sphenoid wing meningioma resection. Her course was complicated with left middle cerebral artery pseudoaneurysm and hemispheric hemorrhage, and an arterial stent and external ventricular drainage catheter were placed. Neurological evaluation showed a minimal conscious state. She presented high fever on the 35th intensive care unit day. Cerebrospinal fluid was sampled and the external ventricular catheter was removed. Enterococcus faecalis was isolated from the culture specimen. The patient received targeted treatment with an ampicillin plus ceftriaxone combination, and a follow-up culture confirmed the pathogen’s eradication. Although she was considered cured, she had a prolonged intensive care unit stay and finally died in the ward two months after the completion of treatment. This case highlights the first reported use of this combination in a severe, non-endocarditis, invasive enterococcal infection, while the review discusses treatment options for nosocomial ventriculitis/meningitis.

show abstract

Intrathecal daptomycin use in a challenging case of Enterococcus faecium ventriculitis

Cited by 2 publications

References 7 publications

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

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

Treatment Options for Nosocomial Ventriculitis/Meningitis: A Case Report and Review of the Literature

Contact Info

Product

Resources

About