万古霉素能否用于鞘内注射?安全剂量是?

万古霉素能否用于鞘内注射?安全剂量是?

[ 本帖最后由 吐纳更新 于 2007-11-3  11:54 编辑 ]

1.3.1.B.4   Intrathecal route
a)  A patient was successfully treated for baclofen pump-associated meningitis (Staphylococcus epidermidis) with intrathecal vancomycin after failing intravenous vancomycin therapy at doses of 1000 milligrams (mg) every twelve hours. An 18 milliliter (mL) solution containing 90 mg of vancomycin (1.8 mL), 3330 micrograms (mcg) of baclofen (6.7 mL), and 9.5 mL of normal saline was prepared, with a final concentration of 5 mg/milliliter (mL) vancomycin and 185 micrograms/mL baclofen. This was delivered by intrathecal pump at a rate of 1 mL per day (5 mg/day of vancomycin). Intrathecal gentamicin and oral rifampin were also used during the treatment course. Intravenous vancomycin was continued for the first 3 days of intrathecal therapy. The CSF showed no growth within 2 weeks of therapy, and therapy was continued for a total of 4 weeks (Zed et al, 2000).
b)  In a review by (Luer & Hatton, 1993), initial intraventricular dosing of vancomycin for ventriculitis/shunt infections or meningitis should range from 5 to 10 milligrams/day in infants and 10 to 20 milligrams/day in adults. This is assuming patients have normal ventricular volumes and CSF dynamics with complete CSF drug distribution. Trough CSF concentrations should be 10 to 20 micrograms/mL; the dose or trough may be adjusted based on clinical response and sensitivity data. In addition, intravenous vancomycin is recommended to be administered concurrently with intraventricular therapy. It has been suggested that intraventricular therapy continue for 3 to 4 days after CSF cultures are negative.

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超出说明书的用法用量一定要注意注意注意！

十分感谢！因为药敏显示只对万古霉素敏感，而且有文章报道万古霉素鞘内注射治疗化脓性脑膜炎病例，但是没有权威性的依据，所以请教大家。谢谢！