PENETRATION OF VANCOMYCIN TO CEREBROSPINAL FLUID (CSF) IN CHILDHOOD 270:

Background: Controlled clinical trials on the effectiveness of perioperative antibiotic prophylaxis for CSF shunt implantations reveal controversial results(1). Pharmacokinetic data of different antibiotics with respect to CSF penetration may in part explain this finding. In order to characterize CSF distribution of i.v. vancomycin (va), we prospectively investigated children with temporary external CSF shunts. Patients and Methods: In 6 children (age 1 month - 10 years), plasma and CSF-samples were taken simultaneously and va concentrations were measured (μg/ml; polarization fluorescence immunoassay; Abbott, Munich, F.R.G.) as well as CSF bact. culture, cell counts and protein concentrations.Results: Mean trough CSF va concentrations were 2.16 μg/ml, mean corresponding plasma concentrations 2.72 μg/ml (n = 12 each), median peak CSF concentrations 2.5 μg/ml, median peak plasma concentrations 14.5μg/ml (n = 4 each). All cultures were sterile.Table Conclusion: Our data indicate, va to penetrate CSF during steady-state at a CSF-pasma ratio of ≈0.8. Va may therefore be useful for perioperative prophylaxis of CSF shunt infections.