Kaiser A B, McGee Z A
N Engl J Med. 1975 Dec 11;293(24):1215-20. doi: 10.1056/NEJM197512112932401.
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.
在7例革兰氏阴性杆菌性脑膜炎发作期间，分别经腰椎、脑室内和全身给药后，研究了氨基糖苷类药物在脑脊液（CSF）空间中的分布情况。其中6例伴有经培养证实的脑室炎。庆大霉素或妥布霉素的肠外治疗在腰椎、脑室和脑池CSF中产生的氨基糖苷类药物浓度较低（低于1.0μg/ml）。向腰椎鞘内空间注射5至10mg氨基糖苷类药物后，腰椎CSF中的浓度为27 - 81μg/ml，但脑室CSF中的浓度为0 - 2.1μg/ml。相比之下，向脑室注射氨基糖苷类药物后，腰椎CSF中的浓度为11.5 - 27.5μg/ml，脑室CSF中的浓度为12.8 - 40μg/ml。通过脑室途径治疗的所有6例均实现了细菌学治愈。脑室内给予氨基糖苷类药物提供了一种在整个蛛网膜下腔实现高氨基糖苷类药物浓度的可靠方法。
