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Systematic Review of Efficacy, Pharmacokinetics, and Administration of Intraventricular Vancomycin in Adults

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Abstract

Central nervous system infections requiring treatment with intraventricular (IVT) vancomycin are becoming increasingly common with advent of intracranial devices and increasing prevalence of multi-drug resistant and nosocomial organisms. Administering vancomycin via IVT route bypasses the blood–brain barrier to allow localized and controlled delivery directly to the desired site of action, achieving high concentrations for more reliable bactericidal action. This article systematically reviews current literature on IVT vancomycin in adults, compiles current knowledge, and integrates available evidence to serve as a practical reference.Medline (1946–July 2012), Embase (1974–July 2012), and International Pharmaceutical Abstracts (1970–July 2012) were searched using terms vancomycin, intraventricular, shunt infection, cerebrospinal fluid, and intraventriculitis. Seventeen articles were included in this review. Indications for IVT vancomycin included meningitis unresponsive to intravenous antibiotics, ventriculitis, and intracranial device infections. No serious adverse effects following IVT vancomycin have been reported. Dosages reported in literature ranged from 0.075–50 mg/day, with the most evidence for dosages of 5 to 20 mg/day. Duration of therapy most commonly ranged from 7 to 21 days. Therapeutic drug monitoring was reported in 11 studies, with CSF vancomycin levels varying widely from 1.1 to 812.6 mg/L, without clear relationships between CSF levels and efficacy or toxicity. Using IVT vancomycin to treat meningitis, ventriculitis, and CNS device-associated infections appears safe and effective based on current evidence. Optimal regimens are still unclear, and dosing of IVT vancomycin requires intricate consideration of patient specific factors and their impact on CNS pathophysiology. Higher-quality clinical trials are necessary to characterize the disposition of vancomycin within CNS, and to determine models for various pathophysiological conditions to facilitate better understanding of effects on pharmacokinetic and pharmacodynamic parameters.

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Authors and Affiliations

  1. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada

    Karen Ng & Mary H. H. Ensom

  2. Lower Mainland Pharmacy Services, Burnaby General Hospital, 3935 Kincaid Street, Burnaby, BC, V5G 2X6, Canada

    Vincent H. Mabasa & Ivy Chow

  3. Department of Pharmacy, 0B7, Children’s and Women’s Health Centre of British Columbia, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada

    Mary H. H. Ensom

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  1. Karen Ng
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  2. Vincent H. Mabasa
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  4. Mary H. H. Ensom
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Correspondence to Vincent H. Mabasa.

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Ng, K., Mabasa, V.H., Chow, I. et al. Systematic Review of Efficacy, Pharmacokinetics, and Administration of Intraventricular Vancomycin in Adults. Neurocrit Care 20, 158–171 (2014). https://doi.org/10.1007/s12028-012-9784-z

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