Adequate intrathecal diffusion of teicoplanin after failure of vancomycin, administered in continuous infusion in three cases of shunt associated meningitis
Jourdan, C.; Convert, J.; Peloux, A.; Boussaid, O.; Grando, J.; Tigaud, S.
Pathologie-Biologie 44(5): 389-392
1996
ISSN/ISBN: 0369-8114 PMID: 8758482 Document Number: 6120
Glycopeptides which have excellent in vitro activity against the Gram-positive causal agents of meningitis unfortunately have a poor CSF penetration. Vancomycin distribution into CSF is improved when administered by a continuous intravenous route and staphylococcal shunt related infection have been reported to be cured. Teicoplanin has good in vitro activity against a lot of staphylococci, and activity superior to vancomycin, against streptococci and is less toxic. In three children with shunt ventriculitis (S epidermidis 2, S. faecalis 1) despite a continuous infusion, vancomycin 15 mg/kg over 60 minutes onset, then 50 mg/kg/day was clinically and bacteriologically ineffective with very poor CSF levels even if high blood levels. After failure of vancomycin we used teicoplanin as a continuous i.v. infusion 6 mg/kg over 60 mn onset, then 12 mg/kg/day. This treatment was quickly effective and well tolerated.
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