Therapeutic vancomycin monitoring in children with hydrocephalus during treatment of shunt infections.

BACKGROUND

The successful treatment of shunt infections in children with hydrocephalus is still an important problem. Diagnosis of shunt colonization is often very difficult. To treat serious central nervous system (CNS) infections, intraventricular therapy with antibiotics is necessary to reach adequate cerebrospinal fluid (CSF) concentrations and eradicate the infection. For optimal management of shunt infections the concentration of administered antibiotics in CSF should be measured. The antibiotic dosing could be modified in the individual patient after pharmacokinetic studies.

METHODS

In our studies, vancomycin was applied to 10 children with hydrocephalus (including 6 with a myelomeningocele) for therapeutic purposes in shunt infections. The drug was administered IV and/or intraventricularly. During treatment the concentration of vancomycin in CSF was determined by fluorescence polarization immunoassay (FPIA) method.

RESULTS

Considerable differences in vancomycin concentrations after the same intraventricular antibiotic administration were observed depending on the patient. The vancomycin levels determined at study state were often much higher than the therapeutic recommended range, and the biologic half-life period (T(1/2)) of vancomycin in cerebrospinal fluid after intraventricular administration was prolonged.

CONCLUSIONS

The results of our studies give information about the pharmacokinetics of vancomycin in CSF in a group of children with hydrocephalus after intraventricular administration of the drug. In our investigation, the administration of doses smaller than 5 mg/24 hours is appropriate when the removed volume of CSF will be 20 to 30 mL/24 hours.