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Correlation between vancomycin penetration into cerebrospinal fluid and protein concentration in cerebrospinal

Masayuki Ishikawa1, Shingo Yamazaki1, Takaaki Suzuki1

  • 1Division of Pharmacy, Chiba University Hospital, Chiba, Japan.

Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy
|November 15, 2018
PubMed

Insights

The ratio of cerebrospinal fluid (CSF) protein to serum albumin can estimate vancomycin (VCM) penetration into the CSF for bacterial meningitis treatment. This helps optimize VCM dosing for better patient outcomes.

Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Clinical Chemistry

Background:

  • Bacterial meningitis requires effective vancomycin (VCM) cerebrospinal fluid (CSF) concentrations for treatment.
  • VCM penetration across the blood-brain barrier (BBB) into CSF varies significantly among patients.
  • Current methods for estimating VCM CSF penetration, like CSF albumin levels, are not routinely performed.

Purpose of the Study:

  • To investigate the relationship between CSF protein concentration/serum albumin ratio and VCM penetration into CSF.
  • To identify a practical marker for estimating VCM CSF concentrations in bacterial meningitis patients.

Main Methods:

  • A retrospective study of 7 patients treated with VCM for suspected bacterial meningitis.
  • Measurement of serum and CSF VCM concentrations.
  • Analysis of the correlation between CSF protein/serum albumin ratio and VCM CSF/serum ratio.

Main Results:

  • Serum VCM concentrations did not significantly correlate with CSF VCM concentrations.
  • A strong positive correlation (r=0.877, p<0.005) was observed between the CSF protein/serum albumin ratio and the VCM CSF/serum ratio.
  • The CSF protein concentration/serum albumin ratio appears to be a useful surrogate marker.

Conclusions:

  • The ratio of CSF protein concentration to serum albumin is a potentially valuable tool for estimating VCM penetration into the CSF.
  • This finding could aid in optimizing VCM dosing strategies for bacterial meningitis.
  • Further research is warranted to validate this ratio in larger patient cohorts.
Keywords:
Bacterial meningitisCerebrospinal fluidTherapeutic drug monitoringVancomycin

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