Aminoglycoside therapy of gram-negative bacillary meningitis

N Engl J Med. 1975 Dec 11;293(24):1215-20. doi: 10.1056/NEJM197512112932401.

Abstract

The distribution of aminoglycosides in the cerebrospinal fluid (CSF) space was examined after intralumbar, intraventricular, and systemic administration during seven episodes of gram-negative bacillary meningitis. Six episodes were associated with culture proved ventriculitis. Parenteral therapy with gentamicin or tobramycin produced low concentrations of aminoglycoside (less than 1.0 mug/ml) in the lumbar, ventricular, and cisternal CSF. Administration of 5 to 10 mg of aminoglycoside into the lumbar intrathecal space resulted in 27-81 mug/ml in the lumbar CSF, but 0-2.1 mug/ml in the ventricular CSF. In contrast, aminoglycoside administered into the cerebral ventricles produced concentrations in the lumbar CSF of 11.5-27.5 mug/ml and ventricular CSF of 12.8-40 mug/ml. All six episodes treated via the ventricular route resulted in a bacteriologic cure. Intraventricular administration of aminoglycosides offers a reliable means of achieving high aminoglycoside concentrations throughout the subarachnoid space.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Anti-Bacterial Agents / administration & dosage*
  • Bacterial Infections / drug therapy*
  • Cerebral Ventricles
  • Child
  • Escherichia coli Infections / drug therapy
  • Gentamicins / administration & dosage*
  • Gentamicins / cerebrospinal fluid
  • Gentamicins / therapeutic use
  • Humans
  • Injections
  • Injections, Spinal
  • Klebsiella Infections / drug therapy
  • Lumbosacral Region
  • Meningitis / drug therapy*
  • Pseudomonas Infections / drug therapy
  • Tobramycin / administration & dosage*
  • Tobramycin / cerebrospinal fluid
  • Tobramycin / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Gentamicins
  • Tobramycin