Association Between Vancomycin Blood Brain Barrier Penetration and Clinical Response in Postsurgical Meningitis

Qing Wang1, Si Chen2, Yan-Gang Zhou1, Ping Xu1, Yi-Ping Liu1, Hua-Lin Cai1, Hong Chen3, Zheng Luo3, Hoan Linh Banh4

1The Second Xiangya Hospital of Central South University, Department of Pharmacy/Institute of Clinical Pharmacy, Changsha, Hunan, P.R. China.
2The Second hospital of Xiangxiang, Department of Pharmacy, Xiangtan, Hunan, P.R. China.
3The Second Xiangya Hospital of Central South University, Department of Neurosurgery, Changsha, Hunan, P.R. China.
4University of Alberta, Faculty of Medicine and Dentistry, Department of Family Medicine, Edmonton, AB, Canada.


PURPOSE: This study investigated the association between vancomycin blood brain barrier penetration and clinical response in patients with postsurgical meningitis. METHODS: Adult patients with postsurgical meningitis were recruited. Eligible patients received vancomycin 500 mg every 6 h for at least 5 days. On day 3 or 4, cerebrospinal fluid (CSF) and simultaneous serum samples were obtained to determine CSF minimum concentrations (Cmin), serum Cmin and CSF to serum Cmin ratio. RESULTS: Twenty-two patients (14 men and 8 women; mean age of 52.6± 12.1 years) were recruited. The vancomycin Cmin was 3.63 ± 1.64 mg/L in CSF and 13.38 ± 5.36 mg/L in serum, with the CSF to serum Cmin ratio of 0.291 ± 0.118. The Cmin in serum and in CSF showed a significant correlation (p=0.005, r =0.575). The vancomycin CSF Cmin had a significant correlation with the decline of white blood cell counts (WBCs) in CSF (p=0.003, r =0.609). CSF Cmin, serum Cmin and CSF to serum Cmin ratio all showed no significant correlation with clinical response (p=0.335, 0.100, 0.679, respectively). CONCLUSIONS: There was a positive correlation between serum Cmin and CSF Cmin. However, only CSF Cmin is positively correlated with WBCs improvement in CSF. All other parameters such as serum Cmin, CSF Cmin and CSF to serum Cmin ratio had no correlation with clinical response.


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J Pharm Pharm Sci, 20 (0): 161-167, 2017

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