Intrathecal injection of tigecycline in treatment of multidrug-resistant<i>Acinetobacter baumannii</i>meningitis: a case report

Wang, Lijiang; Zhang, Jirong; Yu, Xiaoqing; Wang, Jiu-zhong; Cheng, Li-feng; Hu, Shuzhen; Han, Guopeng

doi:10.1136/ejhpharm-2016-000972

Cited by 9 publications

(7 citation statements)

References 15 publications

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“…Tigecycline CSF concentrations after the usual 100 mg IV dose per day are only 0.035–0.048 mg/L, and increasing the daily dose to 200 mg is not well tolerated [ 101 , 102 ]. Several case reports (N = 14) have been described in the literature of IVT tigecycline in the treatment of infections caused by A. baumannii , K. pneumoniae and K. oxytoca ( Table 3 ) [ 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 ]. The dosing regimen using IVT ranged from 1 mg q12h to 10 mg q12h.…”

Section: Resultsmentioning

confidence: 99%

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

2023

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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.

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Section: Resultsmentioning

confidence: 99%

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

2023

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“…The highest concentration of tigecycline in CSF was measured with the combination of 50 mg IV tigecycline and 1 mg IVT tigecycline (2.886 mg/L). Wang et al 10 reported a case of a 45-year-old man who developed MDR A. baumannii meningitis after a lumbar puncture. A dose of 10 mg IVT tigecycline was administered every 12 hours.…”

Section: Discussionmentioning

confidence: 99%

“…Although tigecycline has a rapid distribution into tissues, the concentrations in CSF are low with its intravenous (IV) administration. 10 Therefore, the intraventricular (IVT) usage of tigecycline can be considerable as part of the combined therapy with a carbapenem-containing antibiotic regimen, especially against MDR Klebsi-ella pneumoniae and MDR/XDR Acinetobacter baumannii in adults. However, there have been no randomized controlled trials to evaluate the efficacy of IVT antibiotics for the treatment of central nervous system shunt infections.…”

mentioning

confidence: 99%

Intraventricular tigecycline for the treatment of shunt infection: a case in pediatrics

Curebal¹,

Dalgıç

Bayraktar

2019

Journal of Neurosurgery: Pediatrics

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Ventriculoperitoneal (VP) shunt infections are seen in 3%–17% of patients with VP shunts. These infections may cause severe morbidity and mortality. Staphylococci are the most common cause of CSF shunt-associated infections, although gram-negative bacteria (especially multidrug-resistant [MDR] and extensive drug–resistant [XDR] bacteria) also play an important role. Due to increased antibiotic resistance, sometimes off-label usage of antibiotics is considered. Tigecycline is one of these antibiotics. It should not be used unless there are no other antibiotic treatment options available, especially in children. It belongs to the glycylcycline class of antibiotic agents and inhibits protein translation in bacteria by binding to the 30S ribosomal subunit. The authors describe the case of a patient who had an XDR Klebsiella pneumoniae–positive VP shunt infection. After removal of his VP shunt, an external ventricular drain was inserted, and the patient was treated with a combination of intravenous (1.2 mg/kg/day) and intraventricular (4 mg/day) tigecycline in addition to his meropenem (120 mg/kg/day) treatment. On the 7th day of the combined therapy, his CSF culture was sterile. Because tigecycline distribution into the tissues is not sufficient with intravenous administration, combining it with intraventricular infusion can provide new treatment methods. However, further studies are needed for its use as a treatment method in children.

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“…IVT/IT tigecycline use has recently been described, with success at higher and more frequent doses [88 ▪ ]. The first report describing a reduction of serum and CSF white blood cell count and protein, and CSF clearance of Acinetobacter baumannii , utilized intralumbar tigecycline 10 mg every 12 h [89]. Another case report of IVT tigecycline (5 mg daily) for Klebsiella oxytoca ventriculitis, resulted in CSF concentrations at 6 h that were 15–20 times above the MIC but undetectable at 24 h, suggesting a short tigecycline CSF half-life [88 ▪ ].…”

Section: Intraventricular/intrathecal Antimicrobialsmentioning

confidence: 99%

Antimicrobial use in central nervous system infections

Ciummo

Srinivas

Biedny

2021

Current Opinion in Infectious Diseases

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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.

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Intrathecal injection of tigecycline in treatment of multidrug-resistantAcinetobacter baumanniimeningitis: a case report

Cited by 9 publications

References 15 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

Intraventricular tigecycline for the treatment of shunt infection: a case in pediatrics

Antimicrobial use in central nervous system infections

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