Intrathecal Amikacin for the Treatment of Pseudomonal Meningitis

Corpus, Kimberly; Weber, Kathryn B; Zimmerman, Christopher R.

doi:10.1345/aph.1d541

Cited by 12 publications

(1 citation statement)

References 18 publications

(39 reference statements)

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“…Given that the MIC of amikacin against acinetobacter is usually 16 μg/mL or less,117 a C max /MIC of ten or more is likely to be achieved against most susceptible strains if these concentrations are reached. The caveat to this statement is that while a small number of studies have assessed CSF amikacin concentrations in adults,142,143 these do not give enough information to determine true peak concentrations, and therefore the likelihood of meeting pharmacodynamic targets.…”

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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Section: Treatmentmentioning

confidence: 99%