Administration of Vancomycin at High Doses in Patients with Post Neurosurgical Meningitis: A Comprehensive Comparison between Continuous Infusion and Intermittent Infusion

Abstract

Poor penetration of vancomycin into Central Nervous System (CNS) can lead to treatmentfailure. The aim of this study was to evaluate and compare CSF concentration and serumpharmacokinetics of high dose vancomycin by continuous infusion vs. intermittent infusion inpost neurosurgical meningitis patients. Twenty patients were divided into two groups. Patientsin intermittent infusion group received vancomycin as a loading dose of 25 mg/kg over twohours, followed by 25 mg/kg over two hours every 12 h. In the Continuous Infusion group,patients received vancomycin as a loading dose of 25 mg/kg over two hours, followed by 50mg/kg/day by continuous infusion. In the intermittent infusion group, mean ± SD of serumtrough, peak and CSF concentrations were 17.49 ± 2.46 mg/L, 41.33 ± 2.73 mg/L, and 4.83± 1.05 mg/L, respectively. Mean of CSF/trough% ratio was 27.39 ± 2.43%. A positive linearcorrelation was found between the serum trough levels and CSF levels (r = 0.970, P < 0.001).In continuous infusion group, mean ± SD of serum and CSF concentrations were 24.76 ± 2.02mg/L and 6.20 ± 1.31 mg/L respectively. Mean ± SD of CSF/serum% ratio was 24.84% ±3.54%. The serum and CSF levels revealed positive linear correlation (r = 0.902, P < 0.001).The mean of CSF concentration in CI group was 6.20 ± 1.31 mg/L which was significantlyhigher than II group (4.83 ± 1.05 mg/L, P < 0.019). CSF/serum ratio did not show anysignificant difference between the two groups. Continuous infusion of vancomycin makes itpossible to achieve faster and constant target level in serum but did not have any significanteffect on the penetration (CSF/Serum ratio) of vancomycin in to the CNS.