Intraventricular administration of amikacin for complicated Gram-negative meningitis and ventriculitis

Abstract

Four pediatric neurosurgical patients with Gram-negative meningitis and ventriculitis were treated with parenteral and intraventricular amikacin, a new aminoglycoside. The organisms infecting these patients were resistant to multiple antimicrobial drugs but were sensitive to amikacin. Treatment was continued for 14 days after cerebrospinal fluid cultures became negative. All four patients were cured and have demonstrated no nephrotoxicity, ototoxicity, or evidence of persistent infection on follow-up examination.

Ventriculostomy and Infection: A 4-year-review in a local hospital

“…[10] Amikicin irrigation were used in patients with central nervous system (CNS) infections which include pre-existing meningitis, post traumatic and post-operative CNS infections in the presence of positive bacterial culture in CSF via a ventriculostomy in situ. [15] CSF sampling were performed in cases with fever, raised serum white cell count, impaired mental status, duration of EVD longer than 5 days and manipulations which involved exposing the closed sterile external collection system for drained CSF. Frequent CSF sampling, which we defined as repeated CSF sampling of once every 2 to 3 days for more than 3 occasions, only involved patients with pre-existing meningitis or suspected post operative CNS infections of which frequent CSF sampling via the ventriculostomy was performed to monitor the response to treatment of the respective conditions.…”

Empirical Combination Antibiotic Therapy Improves the Outcome of Nosocomial Meningitis or Ventriculitis in Neuro-Critical Care Unit Patients

“…Van de Beek et al [8] and other authors [12,21] have emphasized the importance of combination empiric antimicrobial therapy for MEN in critically ill neurologic patients because such patients tend to have external drainage devices and a long hospitalization, meaning that they are at high risk of developing MDR, polymicrobial, and multi-organ infections. Thus, ECAT may enhance the likelihood of appropriate therapy in the early phase, treating other concomitant organic infections such as pneumonia and sepsis and shortening the duration of MEN symptoms, which is considered a determinant of outcome [22].…”

Antibióticos intratecales en pacientes adultos

“…En el caso de amikacina, la dosis intraventricular recomendada es de 30 mg al día o 0,3 µg/mL estimado de LCR. Estas dosis han permitido alcanzar concentraciones superiores a los 140 µg/mL en el LCR 42 . En contraste, la terapia sistémica con estos compuestos no permite alcanzar concentraciones bactericidas en el LCR (≤ 3 µg/mL para gentamicina o ≤ 6 µg/mL de amikacina).…”

“…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] .…”

“…Por otra parte, la gentamicina era aplicada con punciones repetidas sobre los ventrículos, una forma de administración que aporta un riesgo intrínseco al procedimiento y que no es utilizada actualmente por el riesgo de porencefalia. Esta información es diferente a la obtenida con numerosos otros estudios que señalan que los aminoglucósidos administrados por vía intratecal se asocian en general a escasos efectos adversos y que se consideran compuestos relativamente seguros 39,42,44,60 . En particular no están asociados a nefrotoxicidad cuando son utilizados en forma intratecal aislada y los posibles efectos ototóxicos han sido inconstantes y sólo observados en algunos reportes.…”