Vancomycin-resistant enterococcal meningitis treated with intrathecal streptomycin

Varelas, Panayiotis N.; Rehman, Mohammed; Pierce, Wendy; Wellwood, Jody; Chua, Thea; Revankar, Sanjay G.

doi:10.1016/j.clineuro.2007.11.005

Cited by 8 publications

(2 citation statements)

References 33 publications

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“…Even when the mycobacteria are resistant to isoniazid and rifampin, standard therapy does not comprise intrathecal streptomycin (87). A 64-year-old man was treated for vancomycinresistant Enterococcus faecalis ventriculitis with 1 to 2 mg streptomycin intrathecally every 12 h plus 3 to 9 mg every 12 h through a drainage catheter placed in a purulent fluid-containing cavity in the right frontotemporal region without signs of hearing loss (88). No pharmacokinetic data are available on streptomycin after intrathecal injection.…”

Section: Aminoglycosidesmentioning

confidence: 99%

Intrathecal Antibacterial and Antifungal Therapies

2020

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SUMMARY Intrathecal administration of anti-infectives is indicated in central nervous system infections by multiresistant pathogens when drugs that can reach adequate cerebrospinal fluid (CSF) concentrations by systemic therapy are not available. Antibiotics that readily pass the blood-brain and blood-CSF barriers and/or that have low toxicity allowing an increase in the daily dosage should not be used for intrathecal therapy. Intrathecal therapy is accompanied by systemic treatment. Antibacterials indispensable for intrathecal therapy include aminoglycosides, colistin, daptomycin, tigecycline, and vancomycin. Limited experience suggests the utility of the antifungals amphotericin B and caspofungin. Intraventricular administration ensures distribution throughout the CSF compartment, whereas intralumbar dosing often fails to attain adequate antibiotic concentrations in the ventricles. The individual dose is determined by the estimated size of the CSF space and by the estimated clearance from CSF. For moderately lipophilic anti-infectives with a molecular weight above approximately 1,000 g/mol, as well as for hydrophilic drugs with a molecular weight above approximately 400 g/mol, one daily dose is normally adequate. The ventricular drain should be clamped for 15 to 120 min to facilitate the distribution of the anti-infective in the CSF space. Therapeutic drug monitoring of the trough levels is necessary only in cases of therapeutic failure.

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Section: Aminoglycosidesmentioning

confidence: 99%

Intrathecal Antibacterial and Antifungal Therapies

2020

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“…Therapeutic strategies have targeted these transporters to increase delivery to the brain through the BBB (Hartz and Bauer, 2010). In some cases, injections of therapeutics directly into the subarachnoid space (intrathecal administration) are used as targeted treatments of diseases in the brain such as tumors and infections (Varelas et al, 2008; Serwer and James, 2012). …”

Section: Choroid Plexus As Target For Pharmacological Treatmentmentioning

confidence: 99%

Na+ dependent acid-base transporters in the choroid plexus; insights from slc4 and slc9 gene deletion studies

et al. 2013

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The choroid plexus epithelium (CPE) is located in the ventricular system of the brain, where it secretes the majority of the cerebrospinal fluid (CSF) that fills the ventricular system and surrounds the central nervous system. The CPE is a highly vascularized single layer of cuboidal cells with an unsurpassed transepithelial water and solute transport rate. Several members of the slc4a family of bicarbonate transporters are expressed in the CPE. In the basolateral membrane the electroneutral Na+ dependent Cl−/HCO3− exchanger, NCBE (slc4a10) is expressed. In the luminal membrane, the electrogenic Na+:HCO3− cotransporter, NBCe2 (slc4a5) is expressed. The electroneutral Na+:HCO3− cotransporter, NBCn1 (slc4a7), has been located in both membranes. In addition to the bicarbonate transporters, the Na+/H+ exchanger, NHE1 (slc9a1), is located in the luminal membrane of the CPE. Genetically modified mice targeting slc4a2, slc4a5, slc4a7, slc4a10, and slc9a1 have been generated. Deletion of slc4a5, 7 or 10, or slc9a1 has numerous impacts on CP function and structure in these mice. Removal of the transporters affects brain ventricle size (slc4a5 and slc4a10) and intracellular pH regulation (slc4a7 and slc4a10). In some instances, removal of the proteins from the CPE (slc4a5, 7, and 10) causes changes in abundance and localization of non-target transporters known to be involved in pH regulation and CSF secretion. The focus of this review is to combine the insights gathered from these knockout mice to highlight the impact of slc4 gene deletion on the CSF production and intracellular pH regulation resulting from the deletion of slc4a5, 7 and 10, and slc9a1. Furthermore, the review contains a comparison of the described human mutations of these genes to the findings in the knockout studies. Finally, the future perspective of utilizing these proteins as potential targets for the treatment of CSF disorders will be discussed.

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Intrathecal drug delivery of antibiotics

Mrowczynski

2023

Cerebrospinal Fluid and Subarachnoid Space

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Vancomycin-resistant enterococcal meningitis treated with intrathecal streptomycin

Cited by 8 publications

References 33 publications

Intrathecal Antibacterial and Antifungal Therapies

Intrathecal Antibacterial and Antifungal Therapies

Na+ dependent acid-base transporters in the choroid plexus; insights from slc4 and slc9 gene deletion studies

Intrathecal drug delivery of antibiotics

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