Penetration of Vancomycin into the Cerebrospinal Fluid: A Systematic Review

Clinical Pharmacokinetics
Jessica E BeachMary H H Ensom

Abstract

Infectious disease and pharmacokinetic textbooks indicate that vancomycin has poor penetration into the central nervous system due to its hydrophilic nature and high molecular weight. Recent literature suggests that penetration of vancomycin into cerebrospinal fluid (CSF) is higher than previously reported; therefore, we conducted a systematic review to assess the penetration of vancomycin into CSF. We searched the MEDLINE, EMBASE, and CENTRAL electronic databases for English-language human studies evaluating serum and CSF concentrations of intravenous vancomycin. In 13 identified studies, the CSF-to-serum ratio of vancomycin varied from 0.00 to 0.81. CSF penetration ranged 0.06-0.81 in patients with meningitis, 0.05-0.17 in ventriculitis, 0.00-0.36 in other infections, and 0-0.13 in patients without infection. Despite variable CSF penetration, 83% of patients with meningitis and 100% of patients with ventriculitis achieved clinical cure. No factor predicted vancomycin CSF penetration. Contrary to prior belief, studies included in our review did not show universally low penetration of vancomycin into CSF. CSF vancomycin levels were variable and did not predict clinical cure.

References

Dec 1, 1991·Antimicrobial Agents and Chemotherapy·P F ViladrichJ Ariza
Oct 1, 1980·Southern Medical Journal·C M NolanT E Brewer
Nov 25, 1998·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·I LutsarI R Friedland
Oct 21, 2004·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Allan R TunkelRichard J Whitley
Dec 3, 2005·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Michael J Rybak
Dec 3, 2005·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Donald P Levine
Jan 25, 2006·Intensive Care Medicine·Anselmo CaricatoMassimo Antonelli
Dec 19, 2006·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Jean-Damien RicardDidier Dreyfuss
Jun 3, 2008·Neurologic Clinics·Wendy C Ziai, John J Lewin
Dec 25, 2008·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Michael RybakDonald P Levine
Dec 14, 2011·Clinical Pharmacokinetics·Amélie MarsotNicolas Simon
May 14, 2014·The Journal of Antimicrobial Chemotherapy·Tawanda GumboHelen McIlleron
Oct 17, 2014·Thérapie·Imen AouintiAnis Klouz
Feb 1, 2015·Clinical Pharmacokinetics·Salmaan KanjiDavid Moher
Aug 5, 2015·Journal of Pharmaceutical Sciences·Xingang LiZhigang Zhao

❮ Previous
Next ❯

Citations

May 29, 2019·Expert Review of Clinical Pharmacology·Nynke G L JagerMenino O Cotta
Jul 16, 2019·Current Opinion in Critical Care·Christopher P Robinson, Katharina M Busl
Mar 13, 2019·Journal of Medical Case Reports·Maxim ClauwaertPieter Depuydt
May 12, 2019·Wiener klinische Wochenschrift·Gary P Wormser, Alan G Barbour
Jan 16, 2020·Intensive Care Medicine·Geert MeyfroidtRomain Sonneville
Nov 18, 2020·British Journal of Clinical Pharmacology·Kris Oliver JalusicMichael Hessler
Nov 16, 2020·European Journal of Pharmaceutical Sciences : Official Journal of the European Federation for Pharmaceutical Sciences·Jaya Madhura ParasuramanAxel Heep
Dec 19, 2020·Expert Review of Anti-infective Therapy·Rodrigo Hasbun
Mar 21, 2021·Current Opinion in Infectious Diseases·Francesco CiummoJessica Biedny
Aug 26, 2021·Chinese Journal of Traumatology = Zhonghua Chuang Shang Za Zhi·Jian YangLei Peng

❮ Previous
Next ❯

Related Concepts

Related Feeds

CSF & Lymphatic System

This feed focuses on Cerebral Spinal Fluid (CSF) and the lymphatic system. Discover the latest papers using imaging techniques to track CSF outflow into the lymphatic system in animal models.

Central Nervous System Bacterial Infections

Central nervous system bacterial infections are medical emergencies and include bacterial meningitis and spinal epidural abscess. Treatment with antibiotics can reduce morbidity and mortality. Discover the latest research on central nervous system bacterial infections here.