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Intrathecal amikacin for the treatment of pseudomonal meningitis

Kimberly A Corpus1, Kathryn B Weber, Christopher R Zimmerman

  • 1Department of Pharmacy Services, Henry Ford Hospital, 2799 W. Grand Boulevard, Detroit, MI 48202-2689, USA. kcorpus1@hfhs.org

The Annals of Pharmacotherapy
|May 4, 2004
PubMed
Abstract

Insights

This case study highlights successful treatment of multidrug-resistant Pseudomonas aeruginosa meningitis using intravenous and intrathecal amikacin. This combination therapy offers a viable option when conventional antibiotics fail, particularly in severe infections.

Area of Science:

  • Infectious Diseases
  • Neuroscience
  • Pharmacology

Background:

  • Gram-negative bacillary meningitis (GNBM) poses significant treatment challenges, especially with multidrug-resistant pathogens.
  • Pseudomonas aeruginosa is a common cause of healthcare-associated infections, including meningitis, often exhibiting resistance to multiple antibiotics.

Observation:

  • A case of a 76-year-old woman with GNBM caused by multidrug-resistant Pseudomonas aeruginosa, secondary to pneumonia and complicated by an extraventricular device.
  • The patient received dual therapy with intravenous meropenem and both intravenous and intrathecal amikacin.
  • Cerebrospinal fluid cultures turned negative after 18 days of treatment, with no adverse effects reported from intrathecal amikacin administration.

Findings:

  • Intravenous and intrathecal amikacin, combined with meropenem, effectively treated multidrug-resistant Pseudomonas aeruginosa meningitis.
  • The patient's meningitis resolved, although she later succumbed to Candida glabrata fungemia.

Implications:

  • Intrathecal and intravenous amikacin combination therapy is a potential treatment option for P. aeruginosa meningitis, especially in cases with limited antibiotic choices due to resistance.
  • This approach may be crucial for severe infections or when standard treatment protocols are insufficient.
  • Further research is needed to establish the efficacy and safety of this dual-route amikacin administration in treating P. aeruginosa meningitis.

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