title: Antimicrobial activity of cefepime and rifampicin in cerebrospinal fluid in vitro.
abstract: OBJECTIVE
  Though used for infections of the central nervous system, the pharmacodynamics of antimicrobial agents is commonly evaluated only in commercially available bacterial growth media. In the present study, the effects of cerebrospinal fluid (CSF) on bacterial killing by cefepime and rifampicin were investigated.
  
  
  METHODS
  CSF was collected from patients who did not receive antibiotics. Time-kill curves were performed over 24 h using drug concentrations of 0.25-, 0.5-, 1-, 2-, 4- and 8-fold the respective MIC for the Staphylococcus aureus test strain. Killing curves were performed in Mueller-Hinton broth (MHB), in CSF incubated in ambient air (CSF(AIR)) and in CSF in air with 5% CO(2) (CSF(CO(2))). CO(2) served to adjust the pH of CSF to physiological values.
  
  
  RESULTS
  Sustained bacterial killing was achieved by cefepime at lower drug concentrations in CSF(CO(2)) than in MHB. In contrast, rifampicin concentrations above the MIC were required to exert sustained killing in CSF(CO(2)). Both drugs were least effective in CSF(AIR).
  
  
  CONCLUSIONS
  Standard susceptibility tests may lead to over- or underestimation of the activity of distinct antibiotics in CSF. Evaluation of the antimicrobial activity in pH-adjusted CSF can provide useful information on drugs considered for the treatment of bacterial infections residing in CSF.
authors.affiliation: Division of Molecular Pharmacokinetics and Imaging, Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. robert.sauermann@meduniwien.ac.at
authors.forename: Robert
authors.initials: R
authors.lastname: Sauermann
authors.forename: Richard
authors.initials: R
authors.lastname: Schwameis
authors.forename: Manfred
authors.initials: M
authors.lastname: Fille
authors.forename: Maria Luciana Camuz
authors.initials: ML
authors.lastname: Ligios
authors.forename: Markus
authors.initials: M
authors.lastname: Zeitlinger
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D000077723:Cefepime; D002511:Cephalosporins / Q000494:pharmacology*; D002555:Cerebrospinal Fluid / Q000382:microbiology*; D015169:Colony Count, Microbial; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D050296:Microbial Viability; D012293:Rifampin / Q000494:pharmacology*; D013211:Staphylococcus aureus / Q000187:drug effects*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime; D012293:Rifampin