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Penetration of intravenous antibiotics into brain abscesses
1Department of Neurosurgery, Tokyo Women's Medical College Dai-ni Hospital, Japan.
Abstract:
INTRA-ABSCESS CONCENTRATIONS OF the intravenously administered latamoxef (LMOX, moxalactam in the United States) and cefotetan (CTT), were studied in 11 patients with intracranial abscess. None of these patients underwent surgical ablation of the abscess. In all cases, the abscess was aspirated, and multiple aspirations were required in five patients. Antibiotic concentrations in 18 aspirates were, therefore, determined by the agar well method. LMOX concentrations in 16 aspirates drawn from nine brain abscess cases ranged from 0 to 10.9 micrograms/ml, with a mean (standard deviation) of 4.18 (3.04) micrograms/ml. The CTT concentration in one patient with a brain abscess was 8.51 micrograms/ml, and the LMOX concentration in the one remaining patient with subdural empyema was 5.20 micrograms/ml. In one patient, the serum-to-pus penetration rate of LMOX was estimated to be 0.11 against the peak value of the concentration in serum or 0.44 against the simultaneously obtained level in serum. Significantly higher concentrations of LMOX were produced in abscess cavities with multiple-dose administration or by prior drainage of pus. More-advanced stages of local inflammation, as demonstrated by computed tomography, correlated with higher concentrations. However, the routine indexes of systemic inflammation, such as body temperature, white blood cell count, and level of C-reactive protein in serum, cannot be used to predict the concentration present in intracerebral pus. A tendency for LMOX concentrations in pus obtained after single dose-administration to decrease with increasing duration from symptom onset to sampling was observed but was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Intracranial abscess antibiotic concentrations of latamoxef (LMOX) and cefotetan (CTT) were measured. Higher LMOX levels were found with multiple doses, prior drainage, and advanced inflammation, but systemic markers did not predict concentrations.
Area of Science:
- Infectious Diseases
- Pharmacology
- Neurosurgery
Background:
- Intracranial abscesses pose significant treatment challenges.
- Optimizing antibiotic delivery to abscess cavities is crucial for effective therapy.
Purpose of the Study:
- To determine intra-abscess concentrations of latamoxef (LMOX) and cefotetan (CTT) in patients with intracranial abscesses.
- To investigate factors influencing antibiotic penetration and concentration within abscesses.
Main Methods:
- Antibiotic concentrations were measured in abscess aspirates using the agar well method.
- Latamoxef and cefotetan levels were analyzed in relation to patient factors and abscess characteristics.
Main Results:
- Latamoxef concentrations in brain abscesses ranged from 0 to 10.9 µg/ml (mean 4.18 µg/ml).
- Higher LMOX concentrations were associated with multiple-dose administration, prior pus drainage, and advanced CT-demonstrated inflammation.
- Serum inflammatory markers did not reliably predict intracerebral pus concentrations.
Conclusions:
- Antibiotic concentrations in intracranial abscesses vary significantly.
- Factors such as dosing regimen, drainage, and local inflammation impact antibiotic levels.
- Systemic inflammatory markers are insufficient for predicting therapeutic antibiotic concentrations within brain abscesses.