title: Nontraditional dosing of ampicillin-sulbactam for multidrug-resistant Acinetobacter baumannii meningitis.
abstract: A 52-year-old man was admitted to a local hospital with headache, nausea, vomiting, dizziness, photophobia, and confusion after a sudden fall. Progressive changes in neurologic function were noted despite neurosurgical intervention and broad-spectrum antimicrobial coverage. Cerebral spinal fluid (CSF) culture identified Acinetobacter baumannii that was resistant to traditionally recommended therapies of amikacin and imipenem-cilastatin. The organism demonstrated minimum inhibitory concentrations of greater than 32 microg/ml and 8 microg/ml, respectively, for these two agents. Ampicillin 2 g-sulbactam 1 g every 3 hours was administered based on history of therapeutic failure of traditional dosing in our thermal injury population. Repeat CSF cultures after 12 days of ampicillin-sulbactam therapy were negative. After 35 days, the patient's A. baumannii infection was completely resolved. The patient experienced no adverse drug events or toxicity with this high-dosage regimen.
authors.affiliation: Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Pennsylvania 19104-4495, USA. m.cawley@usip.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cawley
authors.forename: Caroline
authors.initials: C
authors.lastname: Suh
authors.forename: Susanne
authors.initials: S
authors.lastname: Lee
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Ackerman
mesh_terms: D000150:Acinetobacter / Q000187:drug effects / Q000254:growth & development; D000151:Acinetobacter Infections / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D000667:Ampicillin / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D008875:Middle Aged; D013407:Sulbactam / Q000627:therapeutic use*
chemical_list: C035444:sultamicillin; D000667:Ampicillin; D013407:Sulbactam