cefotaxime and Brain-Injuries

A case of meningitis caused by Streptococcus Equisimilis and cerebrospinal fluid rhinorrhea, in which the head trauma occurred 16 years before, is presented. To the best of the author's knowledge this is the first case reported with such characteristics. Several precipitating factors could be responsible for the unusually late reopening of the fistula Streptococci equisimilis is an uncommon cause of the bacteremia. An appropriate antimicrobrial therapy against S. Equisimilis followed by surgical dural repair were performed.

Topics: Brain Injuries; Cefotaxime; Cerebrospinal Fluid Rhinorrhea; Drug Therapy, Combination; Frontal Lobe; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Middle Aged; Neurosurgical Procedures; Sphenoid Sinus; Streptococcal Infections; Streptococcus; Time Factors; Tomography, X-Ray Computed; Vancomycin

Central nervous system (CNS) antibiotic distribution was described mainly from cerebrospinal fluid data, and only few data exist on brain extracellular fluid concentrations. The aim of this study was to describe brain distribution of cefotaxime (2 g/8 h) by microdialysis in patients with acute brain injury who were treated for a lung infection. Microdialysis probes were inserted into healthy brain tissue of five critical care patients. Plasma and unbound brain concentrations were determined at steady state by high-performance liquid chromatography. In vivo recoveries were determined individually using retrodialysis by drug. Noncompartmental and compartmental pharmacokinetic analyses were performed. Unbound cefotaxime brain concentrations were much lower than corresponding plasma concentrations, with a mean cefotaxime unbound brain-to-plasma area under the curve ratio equal to 26.1 ± 12.1%. This result was in accordance with the brain input-to-brain output clearances ratio (CL(in,brain)/CL(out,brain)). Unbound brain concentrations were then simulated at two dosing regimens (4 g every 6 h or 8 h), and the time over the MICs (T>MIC) was estimated for breakpoints of susceptible and resistant Streptococcus pneumoniae strains. T>MIC was higher than 90% of the dosing interval for both dosing regimens for susceptible strains and only for 4 g every 6 h for resistant ones. In conclusion, brain distribution of cefotaxime was well described by microdialysis in patients and was limited.

Topics: Adult; Aged; Anti-Bacterial Agents; Brain; Brain Injuries; Cefotaxime; Extracellular Fluid; Female; Humans; Lung Diseases; Male; Microbial Sensitivity Tests; Microdialysis; Middle Aged

Topics: Anti-Bacterial Agents; Brain; Brain Injuries; Brain Mapping; Cefotaxime; Cerebrovascular Circulation; Chromatography, Liquid; Female; Humans; Microdialysis; Middle Aged; Treatment Outcome

CT scanning was carried out in 508 patients with acute head injuries. Retrospective analysis of the findings revealed intracranial air in 49 cases (9.7%). Air may be situated in the extradural, subdural or subarachnoid spaces or intracerebrally. A pneumocephalus was detected in 40 out of 49 (82%) of head injury patients within 6 hours of the accident. Injuries associated with a pneumatocele or a single intracranial air bubble have a good prognosis, as do frontobasal lesions. Injuries associated with multiple air bubbles have a bad prognosis. Intracranial air was a sign of a frontobasal or laterobasal fracture. In cases with a depressed skull fracture, extracerebral haematoma or pneumocephalus acting as a space occupying lesion, an operation should be performed as soon as possible. If associated with a persistent rhinorrhea the CSF-fistula should be operated according to the generally accepted rules. In other post-traumatic cases intracranial air may be disregarded, although its presence may influence the choice of treatment.

Topics: Adolescent; Adult; Aged; Brain Injuries; Cefotaxime; Cerebrospinal Fluid Rhinorrhea; Child; Child, Preschool; Female; Gentamicins; Humans; Infant; Male; Middle Aged; Pneumocephalus; Premedication; Prognosis; Skull Fractures; Tomography, X-Ray Computed

The penetration of cefotaxime (CTX) into the cerebrospinal fluid (CSF) was monitored to evaluate the prophylactic efficacy of the drug against post-craniotomy infections. Doses ranged from 1 to 2 g were administered to patients with subarachnoid hemorrhage due to the rupture of cerebral aneurysm, traumatic cerebral contusion, or subdural edema accompanied by intracerebral hemorrhage, by intravenous drip infusion over a period of 30 or 60 minutes. CTX readily entered the CSF with concentrations exceeding MICs against the major pathogens occurring after craniotomy. CTX proved to be effective in the prevention of post-craniotomy infections in noninflammatory situations, especially after surgery in the case of cerebral traumas or subarachnoid hemorrhage.

Topics: Adult; Aged; Bacterial Infections; Brain Injuries; Cefotaxime; Craniotomy; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Postoperative Complications; Subarachnoid Hemorrhage