title: Failure of treatment for chronic Mycobacterium abscessus meningitis despite adequate clarithromycin levels in cerebrospinal fluid.
abstract: We report a case of posttraumatic meningitis due to Mycobacterium abscessus, treated initially with oral clarithromycin and intravenous amikacin plus intrathecal amikacin. Despite cerebrospinal fluid (CSF) levels of clarithromycin and amikacin in excess of their in vitro minimum inhibitory concentrations for the organism, the CSF cultures remained continuously positive for M. abscessus. To our knowledge, this is the first documented case of M. abscessus meningitis and the first report of measured CSF levels of clarithromycin in a patient with meningitis, showing that even therapeutic CSF levels of clarithromycin and amikacin might not be successful in eradicating M. abscessus meningitis.
authors.affiliation: Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA.
authors.forename: C V
authors.initials: CV
authors.lastname: Maniu
authors.forename: W C
authors.initials: WC
authors.lastname: Hellinger
authors.forename: S Y
authors.initials: SY
authors.lastname: Chu
authors.forename: R
authors.initials: R
authors.lastname: Palmer
authors.forename: S
authors.initials: S
authors.lastname: Alvarez-Elcoro
mesh_terms: D000583:Amikacin / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D017291:Clarithromycin / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016920:Meningitis, Bacterial / Q000097:blood / Q000134:cerebrospinal fluid* / Q000188:drug therapy*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009161:Mycobacterium / Q000302:isolation & purification; D009164:Mycobacterium Infections / Q000097:blood / Q000134:cerebrospinal fluid* / Q000188:drug therapy*; D013129:Spinal Puncture; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D000583:Amikacin; D017291:Clarithromycin