title: Levels of vancomycin in the cerebral interstitial fluid after severe head injury.
abstract: OBJECTIVE
  To evaluate the concentrations of vancomycin in the cerebral interstitial fluid after intravenous administration by multiple boli.
  
  
  METHODS
  Prospective non randomized study
  
  
  METHODS
  University hospital general ICU.
  
  
  METHODS
  Four patients undergone to craniotomy for evacuation of cerebral posttraumatic hemorrhage, who developed pneumonia 4-7 days from the injury
  
  
  METHODS
  Two microdialysis catheters were placed in each patient: one in the edematous brain surrounding the focal lesion and one in the subcutaneous tissue of abdomen. Levels of vancomycin were measured in serum and in the microdialysates samples.
  
  
  RESULTS
  Plasmatic concentration of 10-15 microg/ml in the trough level was obtained after four administrations of vancomycin. Levels of vancomycin in the subcutaneous tissue was above minimum inhibitory concentrations in all patients after the second administration. Mean serum/brain ratio was 8%. Cerebral interstitial concentration of vancomycin was never above minimum inhibitory concentrations; its maximum value was 1.2 microg/ml.
  
  
  CONCLUSIONS
  In edematous brain close to a posttraumatic hemorrhage the levels of vancomycin do not differ from that in healthy subjects. At these plasmatic concentrations cerebral interstitial levels of vancomycin were insufficient while subcutaneous interstitial levels were effective for clinical use.
authors.affiliation: Department of Anesthesia and Intensive Care, Catholic University School of Medicine, L.go A.Gemelli, 1 00168, Rome, Italy. anselmo.caricato@fastwebnet.it.
authors.forename: Anselmo
authors.initials: A
authors.lastname: Caricato
authors.affiliation: Department of Anesthesia and Intensive Care, Catholic University School of Medicine, L.go A.Gemelli, 1 00168, Rome, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Pennisi
authors.affiliation: Department of Anesthesia and Intensive Care, Catholic University School of Medicine, L.go A.Gemelli, 1 00168, Rome, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Mancino
authors.affiliation: Department of Anesthesia and Intensive Care, Catholic University School of Medicine, L.go A.Gemelli, 1 00168, Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Vigna
authors.affiliation: Department of Anesthesia and Intensive Care, Catholic University School of Medicine, L.go A.Gemelli, 1 00168, Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Sandroni
authors.affiliation: Department of Anesthesia and Intensive Care, Catholic University School of Medicine, L.go A.Gemelli, 1 00168, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Arcangeli
authors.affiliation: Department of Anesthesia and Intensive Care, Catholic University School of Medicine, L.go A.Gemelli, 1 00168, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000378:metabolism*; D001812:Blood-Brain Barrier; D006259:Craniocerebral Trauma / Q000378:metabolism*; D003399:Craniotomy; D045604:Extracellular Fluid; D006801:Humans; D008297:Male; D017551:Microdialysis; D011446:Prospective Studies; D014640:Vancomycin / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin