Pharmacokinetics of antimicrobial drugs in the cerebrospinal fluid. 1983

H Skopnik, and G Heimann

The physicochemical properties of the blood-to-brain barrier, the cerebrospinal fluid (CSF) to brain barrier, and the blood-CSF barrier, including their specific transport mechanisms, are responsible for drug concentration time courses in the CSF, which increase slower and remain lower than in the serum. From the kinetic point of view the central nervous system (CNS) can be understood as a deep compartment in the organism. During the initial inflammatory phase of a bacterial meningitis, the penetration of antibiotics can be increased. Consequently, sufficient CSF concentrations should be achieved as soon as possible. To investigate the influence of the dosage regimen on the kinetic profile of antibiotics in the CSF, chloramphenicol and cefotaxim were measured using high pressure liquid chromatography (HPLC)-techniques. Five children had a bacterial meningitis and five an external ventricular drainage due to various diseases. Neither continuous infusion over a 12-24-hour-period nor four bolus-injections per day led to sufficient antimicrobial concentrations within the first hours after starting therapy. Using a loading dose of 40-50% of the daily dose administered over a 2-4-hour infusion period and followed by bolus injections, sufficient concentrations of chloramphenicol and cefotaxim could be achieved within a few hours. Besides an adequate choice of antibiotics, the special pharmacokinetic properties of the cerebrospinal membranes should not be neglected in the concept of the antibiotic therapy of meningitis.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D007700 Kinetics The rate dynamics in chemical or physical systems.
D008297 Male Males
D008581 Meningitis Inflammation of the coverings of the brain and/or spinal cord, which consist of the PIA MATER; ARACHNOID; and DURA MATER. Infections (viral, bacterial, and fungal) are the most common causes of this condition, but subarachnoid hemorrhage (HEMORRHAGES, SUBARACHNOID), chemical irritation (chemical MENINGITIS), granulomatous conditions, neoplastic conditions (CARCINOMATOUS MENINGITIS), and other inflammatory conditions may produce this syndrome. (From Joynt, Clinical Neurology, 1994, Ch24, p6) Pachymeningitis,Meningitides,Pachymeningitides
D002439 Cefotaxime Semisynthetic broad-spectrum cephalosporin. Benaxima,Biosint,Cefotaxim,Cefotaxime Sodium,Cefradil,Cephotaxim,Claforan,Fotexina,HR-756,Kendrick,Klaforan,Primafen,Ru-24756,Taporin,HR 756,HR756,Ru 24756,Ru24756,Sodium, Cefotaxime
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D002701 Chloramphenicol An antibiotic first isolated from cultures of Streptomyces venequelae in 1947 but now produced synthetically. It has a relatively simple structure and was the first broad-spectrum antibiotic to be discovered. It acts by interfering with bacterial protein synthesis and is mainly bacteriostatic. (From Martindale, The Extra Pharmacopoeia, 29th ed, p106) Cloranfenicol,Kloramfenikol,Levomycetin,Amphenicol,Amphenicols,Chlornitromycin,Chlorocid,Chloromycetin,Detreomycin,Ophthochlor,Syntomycin
D002851 Chromatography, High Pressure Liquid Liquid chromatographic techniques which feature high inlet pressures, high sensitivity, and high speed. Chromatography, High Performance Liquid,Chromatography, High Speed Liquid,Chromatography, Liquid, High Pressure,HPLC,High Performance Liquid Chromatography,High-Performance Liquid Chromatography,UPLC,Ultra Performance Liquid Chromatography,Chromatography, High-Performance Liquid,High-Performance Liquid Chromatographies,Liquid Chromatography, High-Performance
D004334 Drug Administration Schedule Time schedule for administration of a drug in order to achieve optimum effectiveness and convenience. Administration Schedule, Drug,Administration Schedules, Drug,Drug Administration Schedules,Schedule, Drug Administration,Schedules, Drug Administration

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