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[Intrathecal administration of amikacin in postoperative refractory meningitis]
Abstract:
The intrathecal administration of amikacin (AMK) (50--100 mg/day) was effective for 3 cases of postoperative refractory meningitis caused by gentamicin (GM) resistant organisms. The infecting pathogen of case 1 was K. pneumoniae and that of case 2 was S. epidermidis, while no pathogen was cultured in case 3. The causative pathogens in the former were eradicated only with AMK. No therapeutic response was gained with GM, but with AMK in the latter. High tone hearing impairment was observed in case 1 and transient vomiting was observed in case 3. However, these side effects were trivial for the severity of disease. It is suggested in these 3 cases that the high dose intrathecal administration of AMK may be extremely useful in the treatment of postoperative refractory meningitis which has shown no response to GM.
Insights
High-dose intrathecal amikacin (AMK) effectively treated refractory meningitis resistant to gentamicin (GM). This antibiotic approach offers a vital option for severe infections unresponsive to standard treatments.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Pharmacology
Background:
- Postoperative meningitis can be refractory to standard antibiotic therapies, particularly when caused by resistant organisms.
- Gentamicin (GM) is a common treatment, but resistance necessitates alternative strategies.
Observation:
- Three cases of postoperative refractory meningitis were treated with high-dose intrathecal amikacin (AMK) (50-100 mg/day).
- Infections involved Klebsiella pneumoniae and Staphylococcus epidermidis, with one case having no cultured pathogen.
- Two cases showed resistance to GM, while AMK demonstrated efficacy in all three.
Findings:
- Intrathecal AMK successfully eradicated K. pneumoniae and S. epidermidis in two cases.
- AMK provided a therapeutic response where GM failed.
- Minor, transient side effects (high-tone hearing impairment, vomiting) were observed but deemed trivial compared to the disease severity.
Implications:
- High-dose intrathecal amikacin is a potentially highly effective treatment for postoperative refractory meningitis, especially against GM-resistant pathogens.
- This approach may be crucial for managing severe central nervous system infections with limited therapeutic options.
- Further investigation into optimal dosing and long-term outcomes of intrathecal AMK is warranted.