BackgroundVentriculitis is a complication of temporary intraventricular drains. The limited penetration of meropenem into the cerebrospinal fluid (CSF) is well known. However, ventricular CSF pharmacokinetic data in patients with ventriculitis are lacking. The aim of this study was to evaluate meropenem pharmacokinetics in the serum and CSF of neurocritical care patients with proven or suspected ventriculitis.MethodsWe conducted an observational pharmacokinetic study of neurocritical care patients with proven or suspected ventriculitis receiving meropenem. Multiple blood and CSF samples were taken and were described using nonparametric pharmacokinetic modelling with Pmetrics.ResultsIn total, 21 patients (median age 52 years, median weight 76 kg) were included. The median (range) of peak and trough concentrations in serum were 20.16 (4.40–69.00) mg/L and 2.54 (0.00–31.40) mg/L, respectively. The corresponding peak and trough concentrations in CSF were 1.20 (0.00–6.20) mg/L and 1.28 (0.00–4.10) mg/L, respectively, with a median CSF/serum ratio (range) of 0.09 (0.03–0.16). Median creatinine clearance ranged from 60.7 to 217.6 ml/minute (median 122.5 ml/minute). A three-compartment linear population pharmacokinetic model was most appropriate. No covariate relationships could be supported for any of the model parameters. Meropenem demonstrated poor penetration into CSF, with a median CSF/serum ratio of 9 % and high interindividual pharmacokinetic variability.ConclusionsAdministration of higher-than-standard doses of meropenem and therapeutic drug monitoring in both serum and CSF should be considered to individualise meropenem dosing in neurocritical care patients with ventriculitis.

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Patient medication counseling by a clinical pharmacist prior to discharge improves the patient's knowledge of his drugs as an essential requirement of good compliance. Taking into consideration the economical consequences of noncompliance and the financial problems of the public health system it is advisable to establish this service in German hospitals.

A clinical pharmacist who reviews prescriptions can promote an increase in efficiency, for example, by shortening the course of treatment. Counselling by ward-based clinical pharmacists was shown to be effective to streamline antimicrobial therapy in surgical units and to increase drug safety.

Objectives Data on the clinical impact of a drug information service (DIS) on patient care are still insufficient. By analysing clinical actions following DIS response to enquiries, we studied the impact of a DIS on clinical decision making, specifically concerning drug–drug interactions (DDI). Methods A prospective study, November 2008 to December 2009, identified physicians’ enquiries on DDIs to a university hospital pharmacy DIS. Written response was analysed for reason of enquiry, number and severity of DDI and recommended clinical actions. Enquirers were contacted by telephone and asked what clinical actions had been taken to manage DDI and if they were based on DIS response. Results Out of 149 enquiries on DDI, 113 were patient-specific, made by physicians, and the structured telephone interview was completed. 420 potential DDIs were identified: 85 requiring clinical action, 210 needing observation, 125 theoretical. The telephone interview revealed 232 clinical actions implemented to manage possible DDIs: 114 solely initiated following written DIS response, 118 for other reasons. Out of these 118, many were actually recommended by the DIS but had already been implemented as routine clinical actions during hospital stay like laboratory testing. Reason for enquiry was, in 71 cases preventive, in 18 cases a suspected DDI causing a clinical problem and in 24 cases general DDI-test based on a multidrug regimen. Conclusions The DIS has a direct impact on patient care. Response on DDI enquiries was translated in clinical actions to ensure safe drug therapy, and helps in answering clinical questions.