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Ceftriaxone diffusion into cerebrospinal fluid of children with meningitis
Insights
Ceftriaxone effectively penetrates the cerebrospinal fluid in children with meningitis, with higher concentrations observed early in the illness. These findings support ceftriaxone
Area of Science:
- Pharmacokinetics
- Infectious Diseases
- Pediatrics
Background:
- Meningitis requires effective antimicrobial penetration into the cerebrospinal fluid (CSF).
- Ceftriaxone is a commonly used antibiotic, but its CSF diffusion in pediatric meningitis needs further evaluation.
Purpose of the Study:
- To assess the diffusion of ceftriaxone into the CSF of infants and children with meningitis.
- To determine if ceftriaxone CSF levels are adequate for treating meningitis.
Main Methods:
- 27 pediatric patients with meningitis received a single 75 mg/kg dose of ceftriaxone.
- CSF ceftriaxone levels were measured at 3 and 6 hours post-dose, correlating with illness stage.
- CSF and plasma levels were also analyzed in 3 patients with CSF drainage systems.
Main Results:
- Mean CSF ceftriaxone levels were higher early in meningitis (5.7 µg/ml at 3h, 7.2 µg/ml at 6h) compared to later stages (2.1 µg/ml at 3h, 2.5 µg/ml at 6h).
- CSF diffusion did not correlate with CSF leukocyte count, protein, or glucose levels.
- CSF ceftriaxone levels ranged from 0.7 to 8.3 µg/ml in patients with drainage systems.
Conclusions:
- Ceftriaxone demonstrates sufficient and consistent diffusion into the CSF in pediatric patients with meningitis.
- The drug's penetration supports its potential role in meningitis treatment regimens.
Abstract:
We evaluated the diffusion of ceftriaxone into the cerebrospinal fluid of 27 infants and children with meningitis who were receiving conventional antimicrobic therapy. Ceftriaxone was administered as a single 75 mg/kg dose and was given early or late or both in the course of the illness. Three hours after a dose, the mean cerebrospinal fluid ceftriaxone level was 5.7 micrograms/ml in patients studied early in the course of meningitis and 2.1 micrograms/ml in patients studied later in the illness. Six hours after a dose, the mean cerebrospinal fluid ceftriaxone levels early and late in meningitis were 7.2 and 2.5 micrograms/ml, respectively. The diffusion did not correlate with the leukocyte count or the protein or glucose content of the cerebrospinal fluid. Serial, simultaneous cerebrospinal fluid and plasma ceftriaxone levels were also determined in three additional patients with ventriculo-peritoneal shunt infections and external ventriculostomy drainage. The cerebrospinal fluid ceftriaxone levels in these patients ranged from 0.7 to 8.3 micrograms/ml. Our data indicate that ceftriaxone diffuses sufficiently and consistently into the cerebrospinal fluid to warrant its assessment in the treatment of meningitis.