Penetration of Amoxicillin into Cerebrospinal Fluid

Abstract

The penetration of amoxicillin into cerebrospinal fluid (CFS) in the presence of meningeal inflammation was evaluated in patients with tuberculous meningitis. Serum and CSF concentrations of amoxicillin were measured at 2 h in nine patients who received a 1-g oral dose and at 1.5 and 4 h in ten patients who received a 2-g intravenous injection of sodium amoxicillin. After the oral dose, CSF concentrations ranged from 0.1 to 1.5 μg/ml. After the intravenous injection, CSF concentrations ranged from 2.9 to 40.0 μg/ml at 1.5 h and from 2.6 to 27.0 μg/ml at 4 h. These data on penetration suggest that parenterally administered sodium amoxicillin may be of value in the therapy of acute bacterial meningitis.

Prevention of Surgical Site Infection After Open Prosthetic Inguinal Hernia Repair: Efficacy of Parenteral Versus Oral Prophylaxis with Amoxicillin‐Clavulanic Acid in a Randomized Clinical Trial

“…Thus, the serum amoxicillin levels that would have been achieved with oral prophylaxis and maintained throughout the infectionrisk period should have been adequate to prevent any infection with microorganisms susceptible to amoxicillin, such as S. aureus or S.epidermidis. In addition to serum concentration, investigators have examined concentrations of amoxicillin and clavulanic acid in other body fluids and tissues with several doses of this combination, and adequate antibacterial concentrations are documented in most tissues and fluids [18,[26][27][28][29][30][31][32][33]. Although we did not perform serum or tissue drug concentration analysis in this study, the low SSI rate in our study is in accord with the above findings.…”

Clinical Pharmacokinetics of Cerebrospinal Fluid

“…For instance, an oral I g dose of amoxycillin administered to patients with tuberculous meningitis produced clearly lower maximal concentrations in cerebrospinal fluid (0.1 to 1.5J.1g/ mD than the same dose given intra-324 venously· (2.6 to 4J.1g/mJ) [Strausbaugh et al, 1978}. . In children with infected ventricular shunts, wide variation has been observed in the cerebrospinal fluid concentrations of ampicillin, methicillin and cephalothin, although both intravenous and intraventricular administration routes were used.…”

Infection on expeditions

“…Therefore, meningococcal meningitis and septicemia is a theoretical problem. Although co‐amoxiclav is not licensed for the treatment of meningitis, the amoxycillin component will penetrate inflamed meninges [10] and achieve therapeutic concentrations, and if it is the only parenteral agent available, then it could be used. Some expeditions may wish to carry supplies of a thirdgeneration cephalosporin such as cefotaxime or ceftriaxone to treat suspected meningitis.…”