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Vancomycin cerebrospinal fluid pharmacokinetics in children with cerebral ventricular shunt infections

Julie Autmizguine1, Cassie Moran, Daniel Gonzalez

  • 1From the *Duke Clinical Research Institute; †Department of Pediatrics, Duke University, Durham; ‡Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC; §Department of Pediatric Pharmacology, University of California, San Diego, CA; and ¶Department of Neurosurgery, Duke University, Durham, NC.

The Pediatric Infectious Disease Journal
|April 30, 2014
PubMed

Insights

Vancomycin cerebrospinal fluid (CSF) exposure was evaluated in children with shunt infections. CSF concentrations varied, with some achieving therapeutic levels against staphylococcal infections.

Area of Science:

  • Pediatric Infectious Diseases
  • Neuroscience
  • Pharmacokinetics

Background:

  • Cerebral ventricular shunt infections are serious complications.
  • Intravenous vancomycin is a common treatment for such infections.
  • Understanding vancomycin penetration into cerebrospinal fluid is crucial for effective treatment.

Purpose of the Study:

  • To determine vancomycin cerebrospinal fluid (CSF) exposure in pediatric patients.
  • To assess the relationship between CSF and plasma vancomycin concentrations.
  • To evaluate if CSF vancomycin levels are adequate to treat staphylococcal infections.

Main Methods:

  • Analysis of cerebrospinal fluid (CSF) and plasma vancomycin concentrations.
  • Calculation of CSF to plasma ratios.
  • Evaluation of 8 children receiving intravenous vancomycin for shunt infections.

Main Results:

  • Vancomycin CSF concentrations ranged from 0.06 to 9.13 mg/L.
  • The CSF to plasma ratio varied between 0 and 0.66.
  • Two of three children with staphylococcal infections achieved CSF concentrations above the minimal inhibitory concentration (MIC).

Conclusions:

  • Vancomycin exhibits variable penetration into the CSF in children with shunt infections.
  • Therapeutic CSF concentrations can be achieved, potentially effective against staphylococcal pathogens.
  • Further studies may be warranted to optimize dosing for pediatric shunt infections.

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