Teicoplanin concentration in cerebrospinal fluid during intravenous infusion in patients following neurosurgery operation

Abstract:

ObjectiveTo understand teicoplanin concentration in cerebrospinal fluid (CSF) during intravenous infusion in patients following neurosurgery operation, and evaluate whether drug concentration can be increased if bloodbrain barrier was damaged, and effect of continuous pump of drug on drug concentration in CSF.MethodsThe postneurosurgical surgery patients with surgical site/ventricular drainage were enrolled in the study, patients were divided into routine administration group(a dose of teicoplanin of 400 mg/12 h was administered for 30 min) and continuous administration group (a dose of 400 mg teicoplanin was administered for 30 min followed by a continuous infusion of 200 mg/6 h). CSF specimens were collected at respective time points of administration, teicoplanin concentration in specimens was measured.ResultsFor routine administration group, drug concentration in CSF was（0.004±0.0123）mg/L immediately after teicoplanin was bumped, the peak concentration was (0.712±1.028)mg/L after 1hour bumping, then concentration decreased gradually, which were （0.254±0.222）,（0.173±0.152）, and （0.355±0.207）mg/L at 12,18, and 24 hours of bumping respectively. For continuous administration group, drug concentration in CSF was（0.017±0.020））mg/L immediately after teicoplanin was bumped, the peak concentration reached （0.587±0.255）mg/L after 4hour bumping, then concentration were （0.429±0.416）,（0.325±0.254）,（0.476±0.686）,and （0.318±0.464）mg/L at 6,12,18, and 24 hours of bumping respectively, teicoplanin concentration was relatively stable 6 hours later, which were （0.318±0.464）mg/L（0.476±0.686）mg/L. The area under the curve during 24 hours (AUC024) in routine administration group and continuous administration group were 5.590 mg/ L·h and 9.082 mg/L·h respectively. For two groups of patients, teicoplanin concentration only at the area near peak value achieved 50% minimum inhibitory concentration(MIC50) for coagulase negative staphylococcus (CNS), but the time for achieving concentration higher than CNS MIC50 was far less than 50% of total administration time; teicoplanin concentration in CSF of both groups of patients didn’t achieve MIC50 for Staphylococcus aureus.ConclusionAfter continuous infusion of teicoplanin, drug concentration in CSF can be increased compared with routine administration group,but still can’t achieve the effective MIC; the increase of blood drug concentration is benefit to drug concentration in CSF, it is necessary to increase the dose appropriately to achieve clinical effectiveness.