title: Vancomycin disposition and penetration into ventricular fluid of the central nervous system following intravenous therapy in patients with cerebrospinal devices.
abstract: OBJECTIVE
  To determine the cerebrospinal fluid concentrations and percent CNS penetration of intravenous vancomycin in patients with cerebrospinal devices at a pediatric institution.
  
  
  METHODS
  We performed a prospective evaluation of intravenous (IV) vancomycin in patients who received a single prophylactic dose of vancomycin (15-20 mg/, maximum dose 1 g) prior to insertion of a CNS shunt (group I) or a therapeutic regimen (a dose of 10-20 mg/kg every 6-12 h) for a documented/suspected shunt infection (group II). Ventricular cerebrospinal fluid (VCSF) samples were taken during the procedure in group I and multiple serum and VCSF samples were collected in group II. Pharmacokinetic parameters were calculated using a one-compartment model, and percent CNS penetration was estimated using area-under-the-curve methodology.
  
  
  RESULTS
  Group I: 21 VCSF samples were analyzed from 19 patients (mean age 7.2 +/- 6.4 years). Over 40% of samples failed to have detectable vancomycin concentrations (range 0-2 microg/ml). Group II: 6 patients (mean age 11 +/- 8.7 years) had VCSF concentrations ranging from nondetectable to 6.59 microg/ml (mean 2.48 +/- 0.52 microg/ml). Percent penetration ranged from 0.77 to 18%.
  
  
  CONCLUSIONS
  Single-dose, pre-operative vancomycin results in low VCSF vancomycin concentrations and repeated dosing in patients with documented/presumed device infections yields variable CNS penetration.
authors.affiliation: Center for Pediatric Medicine, Department of Pharmacy, The Children's Hospital, Denver, CO 80218, USA. jorgenson.laney@tchden.org
authors.forename: Laney
authors.initials: L
authors.lastname: Jorgenson
authors.forename: Pamela D
authors.initials: PD
authors.lastname: Reiter
authors.forename: Jane E
authors.initials: JE
authors.lastname: Freeman
authors.forename: Ken R
authors.initials: KR
authors.lastname: Winston
authors.forename: Douglas
authors.initials: D
authors.lastname: Fish
authors.forename: Lori A
authors.initials: LA
authors.lastname: McBride
authors.forename: Michael H
authors.initials: MH
authors.lastname: Handler
mesh_terms: D000293:Adolescent; D000328:Adult; D002490:Central Nervous System / Q000187:drug effects / Q000378:metabolism*; D002555:Cerebrospinal Fluid / Q000187:drug effects / Q000378:metabolism*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male; D008657:Metabolic Clearance Rate / Q000187:drug effects / Q000502:physiology; D011446:Prospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics*
chemical_list: D014640:Vancomycin