Table 1.
Summary of vancomycins’ PK parameters in pediatrics affected with ventriculitis. n represents the number of participants. No data were determined about the CSF penetration.
| Type of Infection |
Study Design (n) |
Dose | Route | Blood and CSF Sampling |
Plasma (mg/L) | CSF (mg/L) | PK Model |
Age | Treatment Outcome/ Remarks |
Ref. |
|---|---|---|---|---|---|---|---|---|---|---|
| Ventriculostomy access device ventriculitis |
Retrospective (8 cases, 7 patients) | 3–15 mg IVT, redosage when CSF concentration < 10 mg/L, in 5 cases concomitant IV 15 mg/kg q24h (<29 weeks postmenstrual age) or q12h (29–35 weeks) |
IVT (+IV) |
Random CSF sampling (only in the presence of a clinical need for accessing the reservoir), 13 pre-dose CSF levels were available, no routine measuring of peak CSF, Source of CSF samples: intraventricular (Ommaya reservoir) |
Ctrough = 6.1 (<2–>100) |
Cmax (3 mg, 19 h) = 24.9 Cmin (3 mg, 59 h) = 3.5 Cmax (5 mg, 14 h) = 96.3 Cmin (5 mg, 43 h) = 2.5 Cmax (10 mg, 24 h) = 94 Cmin (10 mg, 62 h) = 4.2 Cmax (15 mg, 24 h) = 230.7 Cmin (15 mg, 68 h) = 44.9 |
Yes [43] | GA: 25 + 4 weeks (23 + 6–27 +5 weeks) | Resolution in all patients in a median of 5.5 (2–31) days, No adverse events connected to IVT administration |
[25] |
| Shunt ventriculitis |
Retrospective (13 cases, 10 patients) | IVT 20 mg (6 cases)IVT 10 mg (2 cases)IVT 5 mg (5 cases)Concomitant IV in 8 cases (40.5 +/− 9.2 mg/kg/day) |
IVT(+IV) | CSF samples 12 to 120 h following last IVT dose when CSF was absorbed to alleviate intracranial pressure, Source of CSF samples: intraventricular (Ommaya tube/ ventriculoperitoneal shunt) |
Ctrough = 12.3 ± 2.2 | C(20 mg, 24 h) = 125.0 ± 30.1C(20 mg, 78 h) = 28.8 ± 0.8 (A)C(10 mg, 12 h) = 112.8 ± 17.8 (A)C(10 mg, 84 h) =23.2C(5 mg, 24 h) = 39.3 ± 22.9 C(5 mg, 72 h) = 16.5 |
No | GA: 34-week 5 day(±5 weeks 3 days) | Relapse in 2 cases (treated with 10 and 20 mg), Auditory brain response not affected by treatment |
[44] |
| Shunt ventriculitis |
Retrospective (30) | 15 mg/kg q6h | IV | Serum samples 3 (2–5) days after initiation of treatment, only from 11 patients | 8.8 (5.4–27.7) | ND | No | 15.5 (1–192) months |
No recurrent infections |
[45] |
Abbreviations: Cmax: maximum concentration, Cmin: minimum concentration, Ctrough: trough concentration, GA: gestational age, IV: intravenous, IVT: intraventricular, ND: no data, q12h: every 12 h, (A) not reported in study, calculated from individual patient data.