Document Detail


Treatment of staphylococcal ventriculitis associated with external cerebrospinal fluid drains: a prospective randomized trial of intravenous compared with intraventricular vancomycin therapy.
MedLine Citation:
PMID:  12744364     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: Staphylococcal ventriculitis may be a complication in temporary external ventricular drains (EVDs). The limited penetration of vancomycin into the cerebrospinal fluid (CSF) is well known; the pharmacodynamics and efficacy of systemically compared with intraventricularly administered vancomycin is examined in this prospective study. METHODS: Ten patients in whom EVDs were implanted to treat intracranial hemorrhage and who were suffering from drain-associated ventriculitis were randomized into two treatment groups. Five of these patients (median age 47 years) were treated with 2 g/day vancomycin administered intravenously (four infusions/day, Group 1), and the other five(median age 49 years) received 10 mg vancomycin intraventricularly once daily (Group 2). Vancomycin levels were measured in serum and CSF six times a day. The maximum vancomycin level in CSF was 1.73 +/- 0.4 micro/ml in Group 1 and 565.58 +/- 168.71 microg/ml 1 hour after vancomycin application in Group 2 (mean +/- standard deviation). Vancomycin levels above the recommended trough level of 5 microg/ml in CSF were never reached in Group 1, whereas in Group 2 they below the trough level (3.74 +/- 0.66 microg/ml) only at 21 hours after intraventricular vancomycin application. The vancomycin level in the serum was constant within therapeutic levels in Group 1, whereas in Group 2 in most instances vancomycin was almost below a measurable concentration. In both groups bacteriologically and laboratory-confirmed CSF clearance could be obtained. CONCLUSIONS: Intraventricular vancomycin application is a safe and efficacious treatment modality in drain-associated ventriculitis, with much higher vancomycin levels being achieved in the ventricular CSF than by intravenous administration.
Authors:
Bettina Pfausler; Heinrich Spiss; Ronny Beer; Andreas Kampl; Klaus Engelhardt; Maria Schober; Erich Schmutzhard
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  98     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2003 May 
Date Detail:
Created Date:  2003-05-14     Completed Date:  2003-06-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1040-4     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurology and the Central Laboratories, University Hospital, Innsbruck, Austria. b.pfausler@uibk.ac.at
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MeSH Terms
Descriptor/Qualifier:
Adult
Biological Availability
Cerebral Hemorrhage / surgery*
Cerebral Ventricles / drug effects,  microbiology*
Drainage*
Encephalitis / drug therapy*
Female
Humans
Infusions, Intravenous
Injections, Intraventricular
Male
Middle Aged
Staphylococcal Infections / drug therapy*
Surgical Wound Infection / drug therapy*
Treatment Outcome
Vancomycin / administration & dosage*,  adverse effects,  pharmacokinetics
Ventriculostomy*
Chemical
Reg. No./Substance:
1404-90-6/Vancomycin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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