Cefoxitin penetration into cerebrospinal fluid in patients with purulent meningitis

Abstract

The penetration of cefoxitin into cerebrospinal fluid (CSF) was studied in 25 patients with purulent meningitis treated with antibiotics other than cefoxitin. Each patient received three 2-g doses of cefoxitin at 6-h intervals. Blood and CSF samples were obtained before and at 2, 4, or 6 h after the first and third doses. CSF cefoxitin concentrations were found in all patients and varied between 1.2 and 22.0 ,tg/ml, with a majority of the concentrations falling within a range from 1.2 to 6.2 ,ug/ml. The concentrations tended to be higher in CSF samples drawn after the third cefoxitin dose than in those drawn after the first cefoxitin dose, indicating an accumulation of cefoxitin in CSF with repeated doses. Peak cefoxitin concentrations in CSF seemed to occur between 2 and 6 h after intravenous administration of the drug since the highest concentrations were found in patients from whom CSF samples were taken 4 h after the doses. In patients with bacterial meningitis, it should be possible to achieve therapeutic cefoxitin levels in CSF by using nontoxic doses of the antibiotic.Cefoxitin has been found to give concentrations in cerebrospinal fluid (CSF) which are similar to those obtained with ampicillin both in individuals with and in individuals without meningeal inflammation (3, 5). It has been used therapeutically in very few patients with meningitis, and published data (5) of two patients with gram-negative meningitis do not allow the conclusion that cefoxitin is effective in the treat-

Pharmacokinetics of β-Lactam Antibiotics

“…Better penetration in patients without inflamed meninges was noted after multiple intravenous doses of cefoxitin, but when probenecid was given with each dose of cefoxitin, all patients had drug in their CSF . Similar results are reported by HUM-BERT et al (1980), GALVAO et al (1980), andGEDDES et al (1977).…”

Penetration of cefoxitin into cerebrospinal fluid of infants and children with bacterial meningitis

“…These data indicate that CSF penetration of multiple doses of cefoxitin in infants and children with bacterial meningitis is comparable to that previously reported in adult patients (3,7,11). Although the dosage used had no significant adverse effects, these levels in CSF may not be capable of killing all bacterial pathogens.…”

“…Available data are limited on the penetration of cefoxitin into the CSF (3,7,11). Galvao and co-workers (3) gave three 2-g doses of cefoxitin, in addition to ampicillin or.penicillin, to 25 adult patients with purulent meningitis.…”

Mycobacterium fortuitum Meningitis Associated with an Epidural Catheter: Case Report and a Review of the Literature

“…1 Antimicrobial therapy for M. fortuitum meningitis is problematic in that many agents with good in vitro activity have either minimal CSF penetration or the MIC 90 approaches maximum achievable CSF concentrations ( Table 2). [18][19][20][21][22][23][24][25][26] According to published case reports, a variety of treatments have been administered, most frequently combinations of antimicrobials such as cotrimoxazole, doxycycline, kanamycin, amikacin, ofloxacin, and traditional antituberculosis agents isoniazid, rifampin, pyrazinamide, streptomycin, ethionamide, and ethambutol (Table 3). [4][5][6][7][8][9][10][11] In two reports, intravenous therapy with several agents initially failed, but the patients were cured with regimens including intraventricular amikacin.…”