title: The methodology and pharmacokinetics study of intraventricular administration of vancomycin in patients with intracranial infections after craniotomy.
abstract: OBJECTIVE
  The purpose of the study was to investigate the pharmacokinetics of combined intravenous (i.v.) and intracerebroventricular (i.c.v.) vancomycin for patients with intracranial infections after craniotomy and to provide the basis for establishing the intracranial local administration criterion.
  
  
  METHODS
  Fourteen postoperative intracranial infection cases with surgical cavity/ventricular drainages were given vancomycin (1.0 g, i.v. drip for 2 hours, quaque 12 h, and a simultaneous i.c.v. injection of 10 mg). Their blood and cerebral spinal fluid (CSF) specimens were collected at each time point before and after administrations. The concentrations and biochemical properties were measured.
  
  
  RESULTS
  The 1-hour serum vancomycin concentration reached a peak of 46.38 ± 33.39 mg/L; the trough concentration of 48 hours was 8.10 ± 7.11 mg/L; the CSF vancomycin concentration reached a peak of 382.17 ± 421.00 mg/L at 0.25 hours, and the 48-hour trough concentration was 30.82 ± 29.53 mg/L. The inhibitory quotient was calculated at 15.4 by the minimum inhibitory concentration 2 mg/L of target bacteria and had reached the range of 10 to 20 recommended by Infectious Diseases Society of America guidelines. The pH value and osmotic pressure of CSF were found to have no significant changes before and after administration. There was no increasement of seizures and ototoxicity in our study. Before the drug administration and 1 week later, the changes of creatine had no statistically significant, with P > .05.
  
  
  CONCLUSIONS
  The combined i.v. and i.c.v. administration may improve CSF vancomycin concentrations without side effects at the same dosage. Our finding suggests that it can be an option for the treatment of severe intracranial infections after craniotomy; however, its safety and effectiveness need to be confirmed by further large-scale studies.
authors.affiliation: Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China.
authors.forename: Kai
authors.initials: K
authors.lastname: Chen
authors.affiliation: Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China.
authors.forename: Yuanxin
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China. Electronic address: ttyywq@163.com.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Pharmacy Department, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China.
authors.forename: Jiaqing
authors.initials: J
authors.lastname: Wang
authors.affiliation: Pharmacy Department, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China.
authors.forename: Xingang
authors.initials: X
authors.lastname: Li
authors.affiliation: Pharmacy Department, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China. Electronic address: ttyywq@163.com.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China.
authors.forename: Jianxin
authors.initials: J
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood / Q000134:cerebrospinal fluid / Q000493:pharmacokinetics*; D020806:Central Nervous System Bacterial Infections / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000188:drug therapy; D015170:Cerebrospinal Fluid Pressure / Q000187:drug effects; D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007262:Infusions, Intravenous; D007275:Injections, Intravenous / Q000379:methods; D007276:Injections, Intraventricular / Q000379:methods; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013997:Time Factors; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood / Q000134:cerebrospinal fluid / Q000493:pharmacokinetics*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Intracranial infection; Intraventricular administration; Pharmacokinetics; Surgical site infection of neurosurgery; Vancomycin