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[Meningeal diffusion of cefpirome in adults]
P Chavanet1, A Pechinot, A Waldner-Combernoux
1Services des Maladies Infectieuses et Tropicales, Hôpital du Bocage, Centre Hospitalier Régional Universitaire, Dijon.
Abstract:
Cefpirome is a new aminothiazolyl cephalosporin with a low protein binding, a long half-life of elimination and a wide antibacterial spectrum including pseudomonas and staphylococcus. We studied its diffusion into the cerebrospinal fluid (CSF). Cefpirome, 2 g, was administered intravenously over 3 min. Nineteen patients, aged 12-75 y (mean +/- SD = 40 +/- 20) were studied: 13 had meningitis (septic = 6; chronic = 2; viral = 4). Seric and CSF samples were assayed by the high pressure liquid chromatography (HPLC) procedure. Results at 1, 3, 6, 9 and 12 hours after the infusion were (mean +/- SD) 62.44 +/- 19.8 mg/l, 26.51 +/- 3.7 mg/l, 10.19 +/- 3.3 mg/l, 3.99 +/- 2.3 mg/l, 2 +/- 1.72 mg/l in the serum and 1.1 +/- 1 mg/l, 2.6 +/- 1.8 mg/l, 2.83 +/- 1.7 mg/l, 1.92 +/- 1 mg/l, 1.83 +/- 0.36 mg/l in CSF of bacterial meningitidis respectively. The half-life of elimination were 2.45 h and 9.8 h in the blood and CSF respectively. The area under the curve CSF/serum ratio was 28%. We conclude that cefpirome concentrations in the CSF were above the minimal inhibitory concentrations of almost all the bacteria causing meningitis.
Insights
Cefpirome effectively penetrates the cerebrospinal fluid (CSF) in patients with meningitis. CSF concentrations of this antibiotic exceed minimal inhibitory levels for most meningitis-causing bacteria, indicating its therapeutic potential.
Area of Science:
- Pharmacokinetics
- Infectious Diseases
- Neuroscience
Background:
- Cefpirome is a novel aminothiazolyl cephalosporin with broad-spectrum activity, including against Pseudomonas and Staphylococcus.
- It exhibits low protein binding and an extended elimination half-life.
- Understanding its penetration into the cerebrospinal fluid (CSF) is crucial for treating central nervous system infections.
Purpose of the Study:
- To investigate the diffusion and concentration of cefpirome in the CSF of patients with meningitis.
- To determine the pharmacokinetic profile of cefpirome in both serum and CSF.
Main Methods:
- Cefpirome (2 g) was administered intravenously over 3 minutes to 19 patients (13 with meningitis).
- Serum and CSF samples were collected at various time points (1, 3, 6, 9, 12 hours) post-infusion.
- High-performance liquid chromatography (HPLC) was used to quantify cefpirome concentrations.
Main Results:
- Serum concentrations ranged from 62.44 mg/l at 1 hour to 2 mg/l at 12 hours.
- CSF concentrations peaked at 2.83 mg/l between 6 and 9 hours, with a mean elimination half-life of 9.8 hours in CSF compared to 2.45 hours in serum.
- The area under the curve (AUC) CSF/serum ratio was 28%.
Conclusions:
- Cefpirome demonstrates significant penetration into the CSF in patients with meningitis.
- Achieved CSF concentrations are generally above the minimal inhibitory concentrations (MICs) for common bacterial meningitis pathogens.
- Cefpirome shows promise as a treatment option for bacterial meningitis.