title: Instillation of vancomycin into a cerebrospinal fluid reservoir to clear infection: pharmacokinetic considerations.
abstract: Vancomycin instilled in an Ommaya reservoir was used to treat a reservoir-associated infection. Vancomycin concentrations in cerebrospinal fluid (CSF) were measured, and derivation of pharmacokinetic parameters allowed tailoring of dosing. First-order kinetics were observed. The calculated half-life of 3.52 h was less than reported by others, and the apparent volume of distribution (60 ml) was less than anticipated. The elimination constant was 0.197 h-1. Empiric dosing based on schedules suggested in the literature would have led to high peak and low mean concentrations of intrareservoir vancomycin. Patients with reservoir-associated infections have a variety of pathophysiologic conditions that can result in alteration of normal CSF dynamics. Pharmacokinetic analysis is useful to individualize dosing and to optimize therapy with intrareservoir vancomycin.
authors.affiliation: Department of Medicine, North Shore University Hospital, Manhasset, New York 11030.
authors.forename: B E
authors.initials: BE
authors.lastname: Hirsch
authors.forename: M
authors.initials: M
authors.lastname: Amodio
authors.forename: A I
authors.initials: AI
authors.lastname: Einzig
authors.forename: R
authors.initials: R
authors.lastname: Halevy
authors.forename: R
authors.initials: R
authors.lastname: Soeiro
mesh_terms: D000328:Adult; D001682:Biological Availability; D002408:Catheters, Indwelling; D003354:Corynebacterium Infections / Q000188:drug therapy; D006207:Half-Life; D006801:Humans; D007276:Injections, Intraventricular; D008297:Male; D014018:Tissue Distribution; D014640:Vancomycin / Q000008:administration & dosage / Q000134:cerebrospinal fluid / Q000493:pharmacokinetics*
chemical_list: D014640:Vancomycin