Evaluation of Meropenem Penetration into Cerebrospinal Fluid in Patients with Meningitis After Neurosurgery

Area of Science:

• Pharmacokinetics
• Infectious Diseases
• Neurosurgery

Background:

• Meropenem is crucial for managing postneurosurgical meningitis.
• Existing data on meropenem's cerebrospinal fluid (CSF) penetration are limited.
• Understanding CSF penetration is vital for optimizing treatment efficacy.

Purpose of the Study:

• To investigate the pharmacokinetic profile of meropenem in patients with postneurosurgical meningitis.
• To specifically assess meropenem's penetration into the CSF.
• To compare different meropenem dosing regimens.

Main Methods:

• Prospective, open-label study involving 82 patients with postneurosurgical meningitis.
• Patients received meropenem intravenously at 2 g every 8 hours, 1 g every 8 hours, or 1 g every 6 hours.
• Blood and CSF samples were analyzed using high-performance liquid chromatography ultraviolet method after 4 doses.

Main Results:

• Peak CSF concentrations varied by regimen: 2.4 ± 0.3 mg/L (2 g q8h), 1.2 ± 0.2 mg/L (1 g q8h), and 1.6 ± 0.2 mg/L (1 g q6h).
• Maximal CSF penetration percentages were 17.6% ± 7.3% (2 g q8h), 14.3% ± 1.7% (1 g q8h), and 30.9% ± 24.2% (1 g q6h).
• The 1 g every 6 hours and 2 g every 8 hours regimens demonstrated superior CSF penetration.

Conclusions:

• Meropenem dosing regimens of 1 g every 6 hours and 2 g every 8 hours yield higher CSF penetration.
• Increased dosage and reduced dosing interval enhance meropenem's utility for pathogen clearance.
• Optimized dosing strategies are essential for effective treatment of postneurosurgical meningitis.