Summary
In vitro β-lactam antibiotics like ceftriaxone and penicillin G sodium have been shown to be active againstBorrelia burgdorferi. Results of quantitative determinations of both antibiotic substances in the CSF for children are limited. Seventy-five children (median age 96 months, range 10 to 176 months) with probable or definite neuroborreliosis were treated with ceftriaxone (1×50–90 mg/kg/day) or penicillin G sodium (4×80,000–120,000 IU/kg/day) intravenously. On day 10 of therapy levels of penicillin G sodium (1, 1.5, 2, 3, 4, 5, or 6 h after i.v. administration), and ceftriaxone (1, 2, 4, 6, 12 or 24 h after i.v. administration) in serum and CSF were measured with a micro agar diffusion bioassay. Results demonstrate that after 5 h penicillin G sodium in CSF was above the minimal inhibitory concentration (MIC) but after 6 h penicillin G sodium levels were below the determination limit in 60% of the cases. All ceftriaxone results in CSF — even after 24 h — were above MIC. Penicillin G sodium serum values ranged from 46.6 to 0.1 mg/l (1 to 6 h post dose) and ceftriaxone serum values from 261 to 5 mg/l (1 to 24 h post dose). The role of penicillin G sodium and ceftriaxone and administration intervals of both antibiotics in the therapy of neuroborreliosis in children are discussed.
Zusammenfassung
Ceftriaxon und Natrium-Penicillin G sind gegenBorrelia burgdorferi in vitro wirksam. Zur Pharmakokinetik beider Substanzen im Liquor cerebrospinalis von Kindern ist hingegen wenig bekannt. 75 Kinder im Alter von 10 bis 176 Monaten (Median 96) mit einer definitiven oder möglichen Neuroborreliose wurden intravenös mit Ceftriaxon (1×50–90 mg/kg/Tag) oder Penicillin G (4×80000–120000 I.E./kg/Tag) behandelt. Am 10. Therapietag wurden die Liquor-Spiegel von Penicillin G (1, 1.5, 2, 3, 4, 5, oder 6 Stunden nach Gabe) bzw. Ceftriaxon (1, 2, 4, 6, 12, oder 24 Stunden nach Gabe) in Serum und Liquor aus gepaarten Proben mittels einer Mikroagar Diffusions-Methode gemessen. Die Ergebnisse zeigen, daß Penicillin G 5 Stunden nach Gabe noch über der minimalen Hemmkonzentration lag, daß aber 6 Stunden nach Gabe die Konzentration des Antibiotikums in 60% der Liquorproben bereits unterhalb der Meßgrenze lag. Die Ceftriaxon Liquorspiegel lagen durchwegs über der MHK — auch noch 24 Stunden nach der letzten Gabe. Die Serumkonzentrationen von Penicillin G lagen zwischen 46,6 und 0.1 mg/l, die Serumkonzentrationen von Ceftriaxon zwischen 261 und 5 mg/l. Die vorgestellten Ergebnisse werden im Hinblick auf den Stellenwert der beiden Antibiotika in der Therapie der Neuroborreliose im Kindesalter diskutiert.
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Millner, M.M., Thalhammer, G.H., Spork, K.D. et al. β-Lactam antibiotics in the treatment of neuroborreliosis in children: Preliminary results. Infection 24, 174–177 (1996). https://doi.org/10.1007/BF01713334
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DOI: https://doi.org/10.1007/BF01713334