Abstract
Studies of neonatal meningitis have shown the need for antibiotic therapy that reliably reaches the central nervous system (CNS) in therapeutic levels. In four infants being treated for bacterial meningitis or ventriculitis, chloramphenicol levels were measured in serum on 21 occasions and in cerebrospinal fluid (CSF) or ventricular fluid on 21 occasions. Drug levels were determined by a colorimetric procedure which measures only the active form of the drug. Patients received chloramphenicol in doses of 25-35 mg/kg/day divided in two intravenous infusions.
The peak level of chloramphenicol in serum was 36.3 ± 15.3 μg/ml (mean ± S.D.) and the trough level was 24.0 ± 11.8 μg/ml. CNS fluid levels had a mean of 22.2 ± 8.9 μg/ml. Thus, chloramphenicol entered the CNS in therapeutic levels. In 60-90 per cent of serum levels. CNS infection was sterilized within 4 days in two infants with normal CSF dynamics while ventricular fluid was sterile by 5 and 9 days in the infants with pre-existing hydrocephalus. All four infants had a good clinical response and none exhibited signs of chloramphenicol toxicity after 18-21 days of therapy.
With the documentation of adequate and safe therapeutic levels of chloramphenicol in the CNS in premature infants. It seems unnecessary to pursue more invasive techniques for the administration of aminoglycoside antibiotics.
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Dunkle, L., Mcelfresh, A. CENTRAL NERVOUS SYSTEM LEVELS OF CHLORAMPHENICOL IN PREMATURE INFANTS. Pediatr Res 11, 416 (1977). https://doi.org/10.1203/00006450-197704000-00281
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DOI: https://doi.org/10.1203/00006450-197704000-00281