Brief report: Ciprofloxacin in the treatment of gram-negative bacillary meningitis

Schönwald, S; Beus, I; Lisić, Miroslav; Car, Vladimir; Gmajnicki, B

doi:10.1016/0002-9343(89)90071-5

Cited by 31 publications

(10 citation statements)

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“…These and other studies did, nevertheless, uniformly demonstrate penetration of ciprofloxacin into CSF, more so in the presence of inflamed meninges than noninflamed meninges [4,5,7,[10][11][12]. One clinical study reported a good outcome when much higher doses of ciprofloxacin were used [9].…”

Section: Cerebrospinal Fluid Penetration Of High Doses Of Intravenousmentioning

confidence: 84%

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Cerebrospinal Fluid Penetration of High Doses of Intravenous Ciprofloxacin in Meningitis

Lipman

Allworth

Wallis

2000

Clinical Infectious Diseases

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Nosocomial meningitis due to gram-negative organisms is a difficult clinical problem to manage because of both antibiotic resistance and poor penetration of many antimicrobials across the blood-brain barrier. Ciprofloxacin has potential in treating this condition when used in high doses. We investigated the plasma and cerebrospinal fluid (CSF) levels of ciprofloxacin in a patient with Pseudomonas aeruginosa meningitis who was treated with 400 mg of intravenous ciprofloxacin every 8 hours. Ciprofloxacin levels in plasma peaked at 10.29 mg/L without resulting in accumulation (8-hour trough levels, <1 mg/L), whereas the CSF level increased to 0.9 mg/L. This CSF level was confirmed to be similar 1 week later. After 1 week of therapy, during which there were no side effects attributable to ciprofloxacin, the organism was eradicated, and there was some clinical improvement. We recommend that 400 mg of intravenous ciprofloxacin every 8 hours be considered for treatment of difficult-to-treat gram-negative bacillary meningitis.

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Section: Cerebrospinal Fluid Penetration Of High Doses Of Intravenousmentioning

confidence: 84%

“…studies were performed with use of the initial registration dosage, 200 mg q12h [4,5,7,10,11]. These and other studies did, nevertheless, uniformly demonstrate penetration of ciprofloxacin into CSF, more so in the presence of inflamed meninges than noninflamed meninges [4,5,7,[10][11][12].…”

Section: Cerebrospinal Fluid Penetration Of High Doses Of Intravenousmentioning

confidence: 92%

Cerebrospinal Fluid Penetration of High Doses of Intravenous Ciprofloxacin in Meningitis

Lipman

Allworth

Wallis

2000

Clinical Infectious Diseases

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“…Experience with fluoroquinolones for A baumannii meningitis is limited to just four patients, all of whom were cured 36,120,121. Ciprofloxacin concentrations in the CSF reach 6–37% of serum concentrations 122…”

Section: Treatmentmentioning

confidence: 99%

Management of meningitis due to antibiotic-resistant Acinetobacter species

Kim

Peleg

Lodise

et al. 2009

The Lancet Infectious Diseases

195

149

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Acinetobacter meningitis is becoming an increasingly common clinical entity, especially in the postneurosurgical setting, with mortality from this infection exceeding 15%. Infectious Diseases Society of America guidelines for therapy of postneurosurgical meningitis recommend either ceftazidime or cefepime as empirical coverage against Gram-negative pathogens. However, assessment of the pharmacodynamics of these cephalosporins in cerebrospinal fluid suggests that recommended doses will achieve pharmacodynamic targets against fewer than 10% of contemporary acinetobacter isolates. Thus, these antibiotics are poor options for suspected acinetobacter meningitis. From in vitro and pharmacodynamic perspectives, intravenous meropenem plus intraventricular administration of an aminoglycoside may represent a superior, albeit imperfect, regimen for suspected acinetobacter meningitis. For cases of meningitis due to carbapenem-resistant acinetobacter, use of tigecycline is not recommended on pharmacodynamic grounds. The greatest clinical experience rests with use of polymyxins, although an intravenous polymyxin alone is inadvisable. Combination with an intraventricularly administered antibiotic plus removal of infected neurosurgical hardware appears the therapeutic strategy most likely to succeed in this situation. Unfortunately, limited development of new antibiotics plus the growing threat of multidrug-resistant acinetobacter is likely to increase the problems posed by acinetobacter meningitis in the future.

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“…Although combined therapy seems reasonable, the addition of an aminoglycoside does not appear to enhance efficacy, as noted in anecdoctal reports. Ciprofloxacin has been successfully used, as noted in anecdotal reports (37,58,75). However, given the relatively low ratio of cerebrospinal fluid concentrations to MICs for P. aeruginosa (61), ciprofloxacin usage should be confined to situations in which organisms are resistant to beta-lactam agents.…”

Section: Approaches To Specific Infectionsmentioning

confidence: 99%

Antimicrobial agent therapy for Pseudomonas aeruginosa

Korvick

1991

Antimicrob Agents Chemother

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Brief report: Ciprofloxacin in the treatment of gram-negative bacillary meningitis

Cited by 31 publications

References 1 publication

Cerebrospinal Fluid Penetration of High Doses of Intravenous Ciprofloxacin in Meningitis

Cerebrospinal Fluid Penetration of High Doses of Intravenous Ciprofloxacin in Meningitis

Management of meningitis due to antibiotic-resistant Acinetobacter species

Antimicrobial agent therapy for Pseudomonas aeruginosa

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