title: Determination of vancomycin trough level in serum and cerebrospinal fluid of patients with acute community-acquired meningitis: a prospective study.
abstract: BACKGROUND
  Penetration and concentration of vancomycin is still an elusive and complex issue particularly in Cerebrospinal Fluid (CSF). The aim of this study was to clarify the penetration of this antimicrobial agent in CSF during meningeal inflammation.
  
  
  METHODS
  In a prospective study, adult patients, with clinical and CSF analysis compatible with acute meningitis, who received vancomycin (15 mg/kg loading and 30 mg/kg daily maintenance dose) with ceftriaxone (4 gr/daily) were enrolled. CSF analysis including vancomycin trough levels before the fourth maintenance dose and during the 8-10th days of treatment, and simultaneous serum levels were performed by High-Pressure Liquid Chromatography (HPLC).
  
  
  RESULTS
  Twenty-seven patients (18 men, 9 women; mean age of 39.4 ± 14.7) were enrolled. The first serum trough level of vancomycin was 13.82 ± 1.28 mg/l. The mean of corresponding trough level in CSF was 11.2 ± 1.41 mg/l. The serum and CSF trough levels revealed positive linear correlation (r: 0.60) and was significant at the 0.01 level (P: 0.004). The penetration CSF/serum ratio was 0.811 ± 0.082 (coefficient of variation: 10.1%). The second trough levels of serum and CSF in (14 patients) vancomycin were 13.32 ± 1.02 and 10.64 ± 1.21, respectively. The serum and CSF trough levels revealed positive linear correlation (r: 0.71). The serum and CSF concentrations revealed no variation compared to the first trough levels.
  
  
  CONCLUSIONS
  Vancomycin has appropriate concentration in CSF during the treatment of meningitis and do not decrease along with the alleviation of meningeal inflammation in spite of concerns in this regard.
authors: Infectious Diseases and Tropical Medicine Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Shervin
authors: S
authors: Shokouhi
authors: Infectious Diseases and Tropical Medicine Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran; NRITLD, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: ilad13@yahoo.com.
authors: Ilad
authors: I
authors: Alavi Darazam
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000097:blood / Q000134:cerebrospinal fluid / Q000382:microbiology; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D016920:Meningitis, Bacterial / Q000097:blood / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D008875:Middle Aged; D014640:Vancomycin / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Acute; Chromatography; Drug monitoring/methods; High pressure liquid; Human; Meningitis; Vancomycin; Vancomycin/administration/dosage; Vancomycin/pharmacokinetics; Vancomycin/therapeutic use