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Penetration of cefuroxime into ventricular fluid in cerebrospinal fluid shunt infections
M S Edwards1, C J Baker, K M Butler
1Myers Black Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030.
Insights
Cefuroxime effectively penetrates cerebrospinal fluid in pediatric patients with shunt infections, achieving therapeutic levels. This antibiotic successfully treated five of six infections, demonstrating its potential in managing these serious conditions.
Area of Science:
- Infectious Diseases
- Pediatric Neurology
- Pharmacology
Background:
- Ventricular shunt infections are serious complications in pediatric neurosurgery.
- Cerebrospinal fluid penetration of antibiotics is crucial for effective treatment.
Purpose of the Study:
- To assess cefuroxime penetration into ventricular fluid in pediatric patients.
- To evaluate the efficacy of cefuroxime in treating shunt-associated infections.
Main Methods:
- Intravenous cefuroxime administration (200-230 mg/kg/day) in 6 pediatric patients.
- Measurement of cefuroxime levels in ventricular fluid.
- Assessment of cerebrospinal fluid bactericidal titers against Staphylococcus isolates.
Main Results:
- Ventricular fluid cefuroxime levels ranged from 1.6 to 22.5 µg/ml.
- Cerebrospinal fluid bactericidal titers were 1:2 to 1:16.
- Five of six infections were cured with cefuroxime monotherapy.
Conclusions:
- Cefuroxime demonstrates adequate penetration into the cerebrospinal fluid for pediatric shunt infections.
- Cefuroxime is effective in treating a majority of these infections.
- Vancomycin may be considered when MIC data suggests resistance to cefuroxime.
Abstract:
The penetration of intravenously administered cefuroxime into ventricular fluid was assessed in five pediatric patients with ventriculoperitoneal shunt infections and in one with a ventriculostomy infection. Patients received a total dose of 200 to 230 mg of cefuroxime per kg of body weight per day administered at 8-h intervals. Levels of cefuroxime in ventricular fluid ranged from 1.6 to 22.5 micrograms/ml and were associated with cerebrospinal fluid bactericidal titers ranging from less than 1:2 to 1:16 against infecting staphylococcal isolates. Five infections were cured with cefuroxime monotherapy. On the basis of MIC data, one patient had vancomycin substituted for cefuroxime and the infection was cured.