Vancomycin administration into the cerebrospinal fluid: a review.
OBJECTIVE
To discuss administering vancomycin directly into the cerebrospinal fluid (CSF) to treat serious central nervous system (CNS) infections.


METHODS
References were obtained through an online search of MEDLINE, limited to material published in English. In addition, information was extracted from clinical trials, review articles, abstracts, and textbooks.


METHODS
Systematic evaluation of this topic in humans has not been done in a prospective manner. Related research articles describing the pathophysiology of CNS infections, intrathecal drug administration, and case reports of CSF vancomycin administration were reviewed.


METHODS
Case reports regarding CSF vancomycin dosing were evaluated and included: drug dosing, infecting organism, infectious disease state, infectious outcome, CSF dynamics/flow abnormalities, methods of drug administration, drug monitoring, and toxicities.


RESULTS
The results of this review are based on qualitative evaluations of anecdotal case reports and a basic understanding of intrathecal and intraventricular drug dosing principles. CSF administration of vancomycin is an effective means of bypassing the blood-brain barrier to achieve greater drug concentrations within the CSF. Current limitations to the CSF administration of vancomycin include a lack of data describing its safety, efficacy, and pharmacokinetics.


CONCLUSIONS
CNS infections may require the CSF administration of vancomycin for successful eradication. Recommendations for dosing in the literature vary. Because of the potential toxicities associated with elevated CSF concentrations of vancomycin, dosing should be conservative.
Luer
M S
MS
Department of Neurosurgery, University of Kentucky, Lexington.
Hatton
J
J
D002493:Central Nervous System Diseases / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D002555:Cerebrospinal Fluid / Q000502:physiology; D002626:Chemistry, Pharmaceutical; D016903:Drug Monitoring; D016908:Gram-Positive Bacterial Infections / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D006801:Humans; D007276:Injections, Intraventricular; D007278:Injections, Spinal; D008581:Meningitis / Q000134:cerebrospinal fluid / Q000188:drug therapy; D014640:Vancomycin / Q000008:administration & dosage* / Q000134:cerebrospinal fluid / Q000494:pharmacology
D014640:Vancomycin