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Penetration of cefamandole into spinal fluid
Abstract:
Twelve patients, aged 6 months to 62 years, with proven bacterial meningitis, were given a single intravenous dose of cefamandole (33 mg/kg) 75 to 140 min before a routine lumbar puncture. Infecting organisms included Haemophilus influenzae (eight cases), Streptococcus pneumoniae (two cases), and Neisseria meningitidis and beta-hemolytic streptococcus (one each). Cerebrospinal fluid (CSF) was analyzed by microbiological assay for cefamandole. The median concentration was 0.60 mug/ml, ranging from undetectable to 7.4 mug/ml. CSF cefamandole concentrations correlated with CSF protein: in six patients with CSF protein less than 100 mug/dl, the range of drug concentration was 0 to 0.62 mug/ml; and in six patients with CSF protein above 100 mg/dl, the range was 0.57 to 7.4 mug/ml. No significant correlation was noted between severity of illness, type of organism involved, or patient age and concentration of drug achieved.
Insights
Cefamandole concentrations in cerebrospinal fluid (CSF) varied among bacterial meningitis patients. Higher CSF protein levels correlated with increased cefamandole levels, suggesting a potential impact on drug distribution.
Area of Science:
- Pharmacology
- Infectious Diseases
- Neuroscience
Background:
- Bacterial meningitis remains a significant cause of morbidity and mortality.
- Cefamandole is a cephalosporin antibiotic used in treating bacterial infections.
- Understanding antibiotic penetration into the central nervous system is crucial for effective treatment.
Purpose of the Study:
- To determine cefamandole concentrations in cerebrospinal fluid (CSF) of patients with bacterial meningitis.
- To investigate factors influencing cefamandole penetration into the CSF, such as CSF protein levels, patient age, and causative organism.
Main Methods:
- Twelve patients with confirmed bacterial meningitis received a single intravenous dose of cefamandole (33 mg/kg) prior to lumbar puncture.
- CSF samples were collected and analyzed for cefamandole concentrations using microbiological assay.
- Correlation analysis was performed to assess relationships between drug levels and clinical parameters.
Main Results:
- Median CSF cefamandole concentration was 0.60 mug/ml (range: undetectable to 7.4 mug/ml).
- CSF cefamandole concentrations showed a positive correlation with CSF protein levels.
- No significant correlation was found between drug concentration and patient age, illness severity, or specific bacterial pathogens.
Conclusions:
- Cefamandole achieves measurable concentrations in the CSF of patients with bacterial meningitis.
- Cerebrospinal fluid protein levels appear to influence cefamandole distribution into the central nervous system.
- Further research may be warranted to optimize cefamandole dosing strategies in meningitis based on CSF protein levels.