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Pharmacokinetics of cefuroxime in infants and children with bacterial meningitis
Abstract:
A total of 38 patients with bacterial meningitis received either 50 or 75 mg of cefuroxime per kg of body weight given as a 15-min intravenous infusion during the first to third days of therapy. The mean peak plasma concentrations of cefuroxime after doses of 50 and 75 mg/kg were 105 and 152 micrograms/ml, respectively. In five patients, pharmacokinetic values were determined after multiple doses of 50 mg of cefuroxime per kg every 6 h. The mean peak plasma concentrations were 120 micrograms/ml after the first dose and 130 micrograms/ml after the last dose. The concentrations at 6 h were 3.25 and 11.0 micrograms/ml after the first and last doses, respectively. The elimination half-life was approximately 1.5 h, and the apparent volume of distribution was 650 ml/kg. The plasma clearance rate was 195 to 198 ml/min per 1.73 m2. Penetration into the cerebrospinal fluid, expressed as the ratio of the cerebrospinal fluid to serum areas under the curve times 100, was 6.4% in patients given 50 mg of cefuroxime per kg and 10% in those who received 75 mg/kg. The cerebrospinal bactericidal activity in 27 patients was less than or equal to 1:8; only 2 patients had bactericidal activity of less than or equal to 1:2.
Insights
This study on bacterial meningitis found that higher cefuroxime doses (75 mg/kg) led to better cerebrospinal fluid penetration. Cefuroxime demonstrated favorable pharmacokinetics in patients with bacterial meningitis.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Pharmacy
Background:
- Bacterial meningitis requires effective antibiotic therapy.
- Cefuroxime is a cephalosporin antibiotic used for various infections.
- Understanding cefuroxime pharmacokinetics and penetration in cerebrospinal fluid (CSF) is crucial for optimizing treatment in meningitis.
Purpose of the Study:
- To evaluate the pharmacokinetics of cefuroxime in patients with bacterial meningitis.
- To determine the penetration of cefuroxime into the cerebrospinal fluid (CSF) at different dosage regimens.
- To assess the cerebrospinal fluid bactericidal activity of cefuroxime.
Main Methods:
- 38 patients with bacterial meningitis received intravenous cefuroxime at 50 or 75 mg/kg.
- Plasma concentrations and pharmacokinetic parameters were analyzed.
- CSF penetration and bactericidal activity were measured.
Main Results:
- Mean peak plasma concentrations of cefuroxime were 105 and 152 µg/ml for 50 and 75 mg/kg doses, respectively.
- CSF penetration (CSF/serum AUC ratio) was 6.4% at 50 mg/kg and 10% at 75 mg/kg.
- Elimination half-life was ~1.5 hours; plasma clearance was 195-198 ml/min/1.73 m².
Conclusions:
- Cefuroxime exhibits favorable pharmacokinetic properties in bacterial meningitis patients.
- Higher cefuroxime doses enhance penetration into the cerebrospinal fluid.
- Further studies may be warranted to confirm optimal dosing for bactericidal activity.