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Intrathecal or intraventricular colistin: a review
Olivia Bargiacchi1, Francesco Giuseppe De Rosa2
1Infectious Diseases Section, Maggiore della Carità Hospital, Novara, Italy.
Le Infezioni in Medicina
|April 1, 2016
Summary
Intrathecal colistin is an effective treatment for central nervous system (CNS) infections caused by multidrug-resistant Gram-negative bacteria. This review covers its pharmacokinetic properties and clinical use in patients with external ventricular drains.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Pharmacology
Background:
- Central Nervous System (CNS) infections are a significant risk for patients with external ventricular drains.
- Effective antimicrobial therapy requires considering both pathogen susceptibility and blood-brain barrier penetration.
- Multidrug-resistant Gram-negative bacteria pose a treatment challenge in CNS infections.
Purpose of the Study:
- To review the literature on the use of intrathecal/intraventricular colistin for CNS infections.
- To evaluate the pharmacokinetic data of colistin in the CNS.
- To summarize clinical experiences with intrathecal colistin therapy.
Main Methods:
- Literature search of studies on intrathecal/intraventricular colistin use.
- Analysis of pharmacokinetic data regarding blood-brain barrier penetration.
- Synthesis of reported clinical outcomes and safety profiles.
Main Results:
- Colistin demonstrates passage through the blood-brain barrier.
- Intrathecal colistin has shown efficacy against multidrug-resistant Gram-negative bacteria in CNS infections.
- Clinical data suggest colistin is a safe option when administered intrathecally/intraventricularly.
Conclusions:
- Intrathecal colistin is a viable and safe therapeutic option for CNS infections caused by multidrug-resistant Gram-negative bacteria.
- Pharmacokinetic data support its use in achieving adequate drug concentrations in the cerebrospinal fluid.
- Further research may elucidate optimal dosing and long-term outcomes.
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