Meningism intravenous

The desired speed and duration of a therapeutic effed will also influence the development of the final drug product. The standard treatment of meningitis with antibiotics is via intravenous administration so as to achieve an immediate effed. 

Empirical therapy for postoperative infections in neurosurgical patients (including patients with CSF shunts) should include vancomycin in combination with either cefepime, ceftazidime, or meropenem. Linezolid has been reported to reach adequate CSF concentrations and resolve cases of meningitis refractory to vancomycin.35 However, data with linezolid are limited. The addition of rifampin should be considered for treatment of shunt infections. When culture and sensitivity data are available, pathogen-directed antibiotic therapy should be administered. Removal of infected devices is desirable aggressive antibiotic therapy (including high-dose intravenous antibiotic therapy plus intraventricular vancomycin and/or tobramycin) may be effective for patients in whom hardware removal is not possible.36... 

A 26-year-old female with acquired immunodeficiency syndrome (AIDS) develops cryptococcal meningitis. She refuses all intravenous medication. Which antifungal agent can be given orally to treat the meningeal infection ... 

Combinations of amphotericin-B with flucytosine are sometimes used to reduce the occurrence of resistance. Amphotericin-B is not absorbed from the gastrointestinal tract which necessitates intravenous administration. It is 90% protein bound and widely distributed, except for the CNS. For the treatment of fungal meningitis therefore only intrathecal drug administrations can be effective. Amphotericin-B is eliminated very slowly in urine, mainly in an inactive form, with an elimination half-life of about 24 hours which can increase to up to 15 days with repeated doses. 

Intravenous amphotericin plus intravenous or oral flucytosine is the traditional treatment. There is an increasing role for fluconazole, particularly in maintenance therapy in acquired immunodeficiency syndrome (AIDS). The treatment for Cryptococcal meningitis is discussed in Table 15. 

The aim of this study reported by Powderly et al. (1992) was to establish the non-inferiority of a test treatment, fluconazole, compared to an established treatment, amphotericin B, in preventing the relapse of cryptococcal meningitis in HIV-infected patients. It was thought that fluconazole would be less effective than amphotericin B, but would offer other advantages in terms of reduced toxicity and ease of administration fluconazole was an oral treatment while amphotericin B was given intravenously. The non-inferiority margin was set at —15 per cent in terms of relapse rates. 

A clinical diagnosis of bacterial meningitis was made. Therapy was started immediately because of the life-threatening nature of the illness. He was empirically treated with ceftriaxone and vancomycin, intravenously. A short time later, a Gram stain of his CSF revealed that the bacteria were Gram-positive cocci. Accordingly, the empiric... 

Vancomycin is poorly absorbed from the intestinal tract and is administered orally only for the treatment of antibiotic-associated enterocolitis caused by C difficile. Parenteral doses must be administered intravenously. A 1-hour intravenous infusion of 1 g produces blood levels of 15-30 mcg/mL for 1-2 hours. The drug is widely distributed in the body. Cerebrospinal fluid levels 7-30% of simultaneous serum concentrations are achieved if there is meningeal... 

Ceftriaxone Intravenous, third-generation drug, mixed clearance with long half-life (6 hours), good CNS penetration, many uses including pneumonia, meningitis, pyelonephritis, and gonorrhea... 

The intravenous route is preferred in the following situations (1) for critically ill patients (2) for patients with bacterial meningitis or endocarditis (3) for patients with nausea, vomiting, gastrectomy, or diseases that may impair oral absorption and (4) when giving antimicrobials that are poorly absorbed following oral administration. 

Clinical Use. Amphotericin B (Amphocin, Fungizone Intravenous) is one of the primary drugs used to treat severe systemic fungal infections.26,39 This drug is often chosen to treat systemic infections and meningitis caused by Candida, Cryptococcus, and several other... 

---