ArticleAnnals of clinical microbiology and antimicrobials2018
Cerebrospinal fluid penetration of very high-dose meropenem: a case report.
Article in Annals of clinical microbiology and antimicrobials, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.
- A Systematic Review of Studies Reporting Antibiotic Pharmacokinetic Data in the Cerebrospinal Fluid of Critically Ill Patients with Uninflamed Meninges.Antimicrobial agents and chemotherapy · 2020Pooled it
- Fosfomycin as an adjunctive agent against carbapenem-resistant Acinetobacter baumannii: an updated narrative review.Infection · 2026Review
- Meropenem Use and Challenges in Treating Severe Infections in Pakistan Amid Antimicrobial Resistance.Interdisciplinary perspectives on infectious diseases · 2026Review
- New Antibiotics for the Treatment of Nosocomial Central Nervous System Infections.Antibiotics (Basel, Switzerland) · 2024Review
- Clinical Experience with Off-Label Intrathecal Administration of Selected Antibiotics in Adults: An Overview with Pharmacometric Considerations.Antibiotics (Basel, Switzerland) · 2023Review
- The Combination of Amoxicillin and 1,8-Cineole Improves the Bioavailability and the Therapeutic Effect of Amoxicillin in a Rabbit Model.Antibiotics (Basel, Switzerland) · 2022Article
- Current Perspectives on the Diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis.Infection and drug resistance · 2022Review
- Cerebrospinal Fluid Concentrations of Meropenem and Vancomycin in Ventriculitis Patients Obtained by TDM-Guided Continuous Infusion.Antibiotics (Basel, Switzerland) · 2021Article
- Intrathecal Antibacterial and Antifungal Therapies.Clinical microbiology reviews · 2020Review
- Spatio-Temporal Distribution ofMicroorganisms · 2020Review
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundStandard dosing of meropenem (2 g t.i.d.) produces CSF concentrations of only 1-2 mg/L which is inferior to the clinical breakpoint for most Gram-negative bacteria. There is therefore concern that dosing must be increased in order to achieve therapeutic CSF concentrations for bacteria with susceptibility close to clinical breakpoints. Yet, the effects of high-dose meropenem on CSF concentrations are not well described in literature. We therefore determined meropenem CSF-levels in a patient who was treated with 15 g/day of meropenem. CASE PRESENTATION: Our patient suffered from a brain trauma and an external ventricular drainage was implanted. Later, a carbapenemase-producing Acinetobacter baumannii (OXA-23, NDM-1) was isolated from blood cultures and CSF. The MIC for meropenem was > 32 mg/L (R), and we opted for a combination therapy of meropenem, colistin and fosfomycin. Meropenem was given at an unusual high-dose (15 g/day) with the aim of achieving high CSF concentrations. CSF concentrations peaked at 64 mg/L. Yet, the patient succumbed to an intracranial bleed into a preexisting cerebral contusion.
conclusionsHigh-dose meropenem can achieve CSF levels largely superior to those achieved with commonly recommended dosing regimens. Though our patient succumbed to an intracranial bleed which could be regarded as a severe adverse event, we suggest that meropenem dosing can be increased when pathogens with increased MICs are found in the CSF. More in vivo data are however needed to determine the safety of high-dose meropenem.
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