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Treatment of Gram-negative bacillary meningitis with intrathecal gentamicin
Abstract:
In order to evaluate the effect of intrathecal gentamicin on gram-negative bacillary meningitis, twenty-eight patients were treated with intralumbar or intraventricular gentamicin in combination with systemic gentamicin and with other antibiotics. Sterile cerebrospinal fluid was achieved in 21/22 (95%) episodes of documented gram-negative bacillary meningitis in patients who received more than one day of therapy. Seventy-seven percent of these patients survived their infection. The mean cerebrospinal fluid gentamicin level measured 24 hours after intrathecal administration was 5.9 ug/ml following intralumbar administration and 11.1 ug/ml following intraventricular administration. Toxic side effects due to intrathecal administration of gentamicin were not noted. These findings suggest that both intralumbar and intraventricular administration of gentamicin are safe and efficacious in the treatment of gram-negative bacillary meningitis.
Insights
Intrathecal gentamicin effectively treats gram-negative bacillary meningitis, achieving sterile cerebrospinal fluid in 95% of cases. This antibiotic administration method demonstrated a 77% survival rate with no observed toxic side effects in patients.
Area of Science:
- Infectious Diseases
- Pharmacology
- Neurology
Background:
- Gram-negative bacillary meningitis poses a significant threat, often requiring intensive treatment.
- Intrathecal antibiotic delivery is explored for direct central nervous system infection management.
Purpose of the Study:
- To evaluate the efficacy and safety of intrathecal gentamicin for treating gram-negative bacillary meningitis.
- To assess gentamicin concentrations in cerebrospinal fluid following intralumbar and intraventricular administration.
Main Methods:
- Twenty-eight patients with gram-negative bacillary meningitis received intralumbar or intraventricular gentamicin combined with systemic antibiotics.
- Cerebrospinal fluid (CSF) gentamicin levels were measured 24 hours post-administration.
- Treatment outcomes, including CSF sterility and patient survival, were recorded.
Main Results:
- Sterile CSF was achieved in 95% of documented gram-negative bacillary meningitis episodes with >1 day of therapy.
- Seventy-seven percent of treated patients survived their infection.
- Mean CSF gentamicin levels were 5.9 ug/ml (intralumbar) and 11.1 ug/ml (intraventricular).
Conclusions:
- Intrathecal gentamicin, via intralumbar or intraventricular routes, is safe and effective for gram-negative bacillary meningitis.
- This administration method aids in achieving CSF sterility and improving patient survival rates.
- No toxic side effects were observed from intrathecal gentamicin administration.