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[Diffusion of fosfomycin into the cerebrospinal fluid in purulent meningitis]
Abstract:
Cerebrospinal fluid levels of fosfomycin were measured in 10 patients with bacterial meningitis. Fosfomycin 200 mg/kg/day was administered in three 4-hour intravenous infusions. The antibiotic was associated with amoxicillin in 9 patients and with cefotaxime in one. Cerebrospinal fluid was obtained on the 2nd and 5th days of treatment, 2 hours after the end of the infusion. The mean CSF fosfomycin levels were 31 mg/l on the 2nd day and 37.2 mg/l on the 5th day. These levels were higher than the MIC 90 for most bacteria encountered in meningitis. Fosfomycin could be used to treat some cases of bacterial meningitis, but always in association with another antibiotic.
Insights
Fosfomycin shows promising cerebrospinal fluid (CSF) levels in bacterial meningitis patients, exceeding minimum inhibitory concentrations for common pathogens. It may be a viable treatment option when combined with other antibiotics.
Area of Science:
- Pharmacology
- Infectious Diseases
- Neuroscience
Context:
- Bacterial meningitis remains a significant cause of morbidity and mortality worldwide.
- Effective antibiotic penetration into the cerebrospinal fluid (CSF) is crucial for successful treatment.
- Fosfomycin is a broad-spectrum antibiotic with potential utility against resistant pathogens.
Purpose:
- To evaluate the penetration and concentration of fosfomycin in the CSF of patients with bacterial meningitis.
- To determine if CSF fosfomycin levels are adequate to inhibit common meningitis-causing bacteria.
Summary:
- Ten patients with bacterial meningitis received intravenous fosfomycin (200 mg/kg/day) in combination with amoxicillin or cefotaxime.
- Cerebrospinal fluid (CSF) samples were collected on days 2 and 5 of treatment.
- Mean CSF fosfomycin concentrations were 31 mg/l on day 2 and 37.2 mg/l on day 5, exceeding the MIC 90 for most relevant bacteria.
Impact:
- Fosfomycin achieves therapeutic concentrations in the CSF during bacterial meningitis treatment.
- These findings support the potential use of fosfomycin as part of combination therapy for bacterial meningitis.
- Further research may explore optimal dosing and efficacy in diverse meningitis etiologies.