Vancomycin disposition and penetration into ventricular fluid of the central nervous system following intravenous therapy in patients with cerebrospinal devices

Objective/Aims: To determine the cerebrospinal fluid concentrations and percent CNS penetration of intravenous vancomycin in patients with cerebrospinal devices at a pediatric institution. Methods: We performed a prospective evaluation of intravenous ( IV) vancomycin in patients who received a single prophylactic dose of vancomycin (15-20 mg/, maximum dose 1 g) prior to insertion of a CNS shunt ( group I) or a therapeutic regimen ( a dose of 10-20 mg/ kg every 6-12 h) for a documented/ suspected shunt infection ( group II). Ventricular cerebrospinal fluid ( VCSF) samples were taken during the procedure in group I and multiple serum and VCSF samples were collected in group II. Pharmacokinetic parameters were calculated using a one-compartment model, and percent CNS penetration was estimated using area-under-the- curve methodology. Results: Group I: 21 VCSF samples were analyzed from 19 patients ( mean age 7.2 +/- 6.4 years). Over 40% of samples failed to have detectable vancomycin concentrations ( range 0-2 mu g/ ml). Group II: 6 patients ( mean age 11 +/- 8.7 years) had VCSF concentrations ranging from nondetectable to 6.59 mu g/ml ( mean 2.48 +/- 0.52 mu g/ml). Percent penetration ranged from 0.77 to 18%. Conclusions: Single-dose, pre-operative vancomycin results in low VCSF vancomycin concentrations and repeated dosing in patients with documented/presumed device infections yields variable CNS penetration.