Instillation of Vancomycin into a Cerebrospinal Fluid Reservoir to Clear Infection: Pharmacokinetic Considerations

• Published in: The Journal of infectious diseases Vol. 163; no. 1; pp. 197 - 200
• Main Authors: Hirsch, Bruce E., Amodio, Maria, Einzig, Avi I., Halevy, Rachel, Soeiro, Ruy
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.01.1991; University of Chicago Press
• Subjects: Adult; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Biological Availability; Catheters, Indwelling; Cerebrospinal fluid; Concise Communications; Corynebacterium; Corynebacterium Infections - drug therapy; Disease reservoirs; Dosage; Half lives; Half-Life; Humans; Infections; Injections, Intraventricular; Intravenous injections; Kinetics; Male; Medical sciences; Pharmacokinetics; Pharmacology. Drug treatments; Radiotherapy; Tissue Distribution; Vancomycin - administration & dosage; Vancomycin - cerebrospinal fluid; Vancomycin - pharmacokinetics; Infection; Human; Delivery system; Antibiotic; Chemotherapy; Treatment; Bacteriosis; Complication; Antibacterial agent; Pharmacokinetics; Intrathecal administration
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/163.1.197

Vancomycin instilled in an Ommaya reservoir was used to treat a reservoir-associated infection. Vancomycin concentrations in cerebrospinal fluid (CSF) were measured, and derivation of pharmacokinetic parameters allowed tailoring of dosing. First-order kinetics were observed. The calculated half-life of 3.52 h was less than reported by others, and the apparent volume of distribution (60 ml) was less than anticipated. The elimination constant was 0.197 h−1, Empiric dosing based on schedules suggested in the literature would have led to high peak and low mean concentrations of intrareservoir vancomycin. Patients with reservoir-associated infections have a variety of pathophysiologic conditions that can result in alteration of normal CSF dynamics. Pharmacokinetic analysis is useful to individualize dosing and to optimize therapy with intrareservoir vancomycin.