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Vancomycin: its effect on intracranial pressure

S J Gaskill1, A E Marlin

  • 1Division of Neurosurgery, Duke University Medical Center, Durham, N.C.

Pediatric Neurosurgery
|January 1, 1992
PubMed

Insights

Vancomycin antibiotic use may increase intracranial pressure (ICP) in patients with brain conditions. This study observed significant ICP elevations during and after vancomycin administration in both human patients and animal models.

Area of Science:

  • Neurosurgery
  • Pharmacology
  • Critical Care Medicine

Background:

  • Vancomycin is a critical antibiotic in neurosurgery.
  • Vancomycin is known to cause histamine release, which can experimentally increase intracranial pressure (ICP).
  • Initial observations suggested a link between vancomycin infusion and elevated ICP in patients.

Purpose of the Study:

  • To formally evaluate the effect of vancomycin administration on intracranial pressure (ICP) in neurosurgical patients.
  • To investigate the impact of vancomycin on ICP in an animal model.
  • To inform clinical practice regarding vancomycin use in patients with intracranial pathology.

Main Methods:

  • Data collected from 6 neurosurgical patients with external ventricular drainage.
  • ICP measurements taken before, during, and after vancomycin infusion.
  • Animal model used to replicate vancomycin's effect on ICP.
  • Repeated measures analysis of variance used for statistical analysis.

Main Results:

  • In patients, mean ICP increased from 8 mm Hg to 13.8 mm Hg during vancomycin infusion and remained elevated at 12.6 mm Hg post-infusion (p < 0.0001).
  • In animals, mean ICP rose from 1.95 mm Hg to 8.4 mm Hg during infusion and was 5.6 mm Hg post-infusion (p < 0.0001).
  • Both patient and animal data showed statistically significant increases in ICP associated with vancomycin.

Conclusions:

  • Vancomycin administration is associated with significant elevations in intracranial pressure.
  • The increase in ICP persists even after vancomycin infusion has ceased.
  • Clinicians should exercise caution when using vancomycin in patients with existing intracranial pathology.

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