Bactericidal activity of vancomycin in cerebrospinal fluid.
Intraventricular application of vancomycin is an effective therapeutic regimen for the treatment of shunt-associated staphylococcal ventriculitis. We examined the in vitro activity of vancomycin at high concentrations against Staphylococcus aureus ATCC 25923 and Staphylococcus epidermidis ATCC 12228 in human cerebrospinal fluid samples. Time-kill curves revealed equal efficacies for concentrations of 10, 100, and 300 microg/ml, and incubation times of 24 to 48 h were needed to achieve a 3 log(10) reduction of viable bacteria. A concentration of 5 microg/ml showed a slightly lower activity, but this difference was not significant. In an infant who was successfully treated for shunt-associated ventriculitis due to S. epidermidis by once-daily local administration of vancomycin (3 mg for 2 days and 5 mg for 4 days [0. 5 to 0.8 mg/kg of body weight]) the in vivo kill kinetics were similar to those for the in vitro results. These results support time-dose regimens that provide trough vancomycin levels of 5 to 10 microg/ml.
Nagl
M
M
Institute for Hygiene, Leopold-Franzens-University of Innsbruck, University Hospital of Innsbruck, Austria. waldemar.gottardi@uibk.ac.at
Neher
C
C
Hager
J
J
Pfausler
B
B
Schmutzhard
E
E
Allerberger
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000134:cerebrospinal fluid* / Q000494:pharmacology*; D002453:Cell Cycle; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007700:Kinetics; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013211:Staphylococcus aureus / Q000187:drug effects; D013212:Staphylococcus epidermidis / Q000187:drug effects; D014640:Vancomycin / Q000134:cerebrospinal fluid* / Q000494:pharmacology*
D000900:Anti-Bacterial Agents; D014640:Vancomycin