Amikacin concentration in the cerebrospinal fluid of children with acute bacterial meningitis
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Amikacin effectively penetrates cerebrospinal fluid (CSF) in children with bacterial meningitis, reaching therapeutic levels within hours of intramuscular administration. CSF concentrations correlate with serum levels and clinical improvement, aiding treatment predictability.
Area of Science:
- Pharmacology
- Pediatrics
- Infectious Diseases
Background:
- Bacterial meningitis remains a significant pediatric health concern.
- Aminoglycosides like amikacin are crucial in treating bacterial infections.
- Understanding amikacin penetration into the cerebrospinal fluid (CSF) is vital for effective meningitis treatment.
Purpose of the Study:
- To evaluate amikacin penetration into the CSF of pediatric patients with acute bacterial meningitis.
- To assess the relationship between amikacin CSF concentrations, serum levels, and therapeutic outcomes.
- To determine the predictability of patient response based on in vitro and in vivo amikacin concentrations.
Main Methods:
- Twenty children with acute bacterial meningitis were studied.
- Amikacin was administered intramuscularly at 7.5 mg/kg.
- CSF and serum samples were collected at various times post-administration and during therapy.
- In vitro Minimum Inhibitory Concentration (MIC) values were correlated with CSF concentrations.
Main Results:
- Amikacin CSF concentrations mirrored serum concentrations over time.
- 76% of CSF samples achieved a minimum concentration of 2 microgram/ml between 0.5 and 7 hours post-administration.
- A mean serum/CSF ratio of 3:1 was observed up to 7 hours in patients with clinical improvement.
- Patient response was predictable in 3 out of 6 treated patients by correlating MIC with CSF concentration.
Conclusions:
- Amikacin demonstrates adequate penetration into the CSF of children with bacterial meningitis.
- Therapeutic amikacin levels in CSF are achievable and correlate with clinical response.
- Correlation of in vitro MIC with in vivo CSF concentrations shows potential for predicting treatment outcomes.
Abstract:
Penetration of the aminoglycoside, amikacin, into the cerebrospinal fluid (CSF) of twenty children with acute bacterial meningitis was studied at various times after intramuscular administration and at various stages of therapy. Six of the patients were evaluated during therapy with amikacin at 7.5 mg/kg (intramuscularly) every 12 hours plus ampicillin every 6 hours at 300 mg/kg/day (intravenously); thirteen of the remaining fourteen patients were treated with ampicillin alone, but were given a single intramuscular dose of 7.5 mg/kg of amikacin for evaluation of CSF concentration. Amikacin concentration in CSF with respect to time after administration followed essentially the same pattern as in serum. A minimum concentration of 2 microgram/ml was found in 76% of the CSF samples obtained between 0.5 and 7 hours after administration. A mean amikacin serum/CSF ratio of 3:1 was demonstrated up to 7 hours after dose in all patients who underwent clinical improvement. Patient response was predictable by a correlation of in vitro MIC values with in vivo CSF concentration in three of the six patients who received amikacin therapy.