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Systematic review of efficacy, safety and pharmacokinetics of intravenous and intraventricular vancomycin for central nervous system infections

Affiliation
Key Laboratory of Major Diseases in Children ,National Center for Children’s Health ,Ministry of Education ,Department of Infectious Diseases ,Beijing Children’s Hospital ,Capital Medical University ,Beijing ,China
Liu, Shu-Ping;
Affiliation
Key Laboratory of Major Diseases in Children ,Beijing Key Laboratory of Pediatric Respiratory Infection Diseases ,National Clinical Research Center for Respiratory Diseases ,Ministry of Education ,National Key Discipline of Pediatrics (Capital Medical University) ,Beijing Pediatric Research Institute ,Beijing Children’s Hospital ,Capital Medical University ,Beijing ,China
Xiao, Jing;
Affiliation
Center for Clinical Epidemiology and Evidence-based Medicine ,National Center for Children’s Health ,Beijing Children’s Hospital ,Capital Medical University ,Beijing ,China
Liu, Ya-Li;
Affiliation
Key Laboratory of Chemical Biology (Ministry of Education) ,Department of Clinical Pharmacy ,School of Pharmaceutical Sciences ,Cheeloo College of Medicine ,Shandong University ,Jinan ,China
Wu, Yue-E;
Affiliation
Key Laboratory of Major Diseases in Children ,Beijing Key Laboratory of Pediatric Respiratory Infection Diseases ,National Clinical Research Center for Respiratory Diseases ,Ministry of Education ,National Key Discipline of Pediatrics (Capital Medical University) ,Beijing Pediatric Research Institute ,Beijing Children’s Hospital ,Capital Medical University ,Beijing ,China
Qi, Hui;
Affiliation
Key Laboratory of Major Diseases in Children ,National Center for Children’s Health ,Ministry of Education ,Department of Infectious Diseases ,Beijing Children’s Hospital ,Capital Medical University ,Beijing ,China
Wang, Zhuang-Zhuang;
Affiliation
Key Laboratory of Major Diseases in Children ,Beijing Key Laboratory of Pediatric Respiratory Infection Diseases ,National Clinical Research Center for Respiratory Diseases ,Ministry of Education ,National Key Discipline of Pediatrics (Capital Medical University) ,Beijing Pediatric Research Institute ,Beijing Children’s Hospital ,Capital Medical University ,Beijing ,China
Shen, A-Dong;
Affiliation
Key Laboratory of Major Diseases in Children ,National Center for Children’s Health ,Ministry of Education ,Department of Infectious Diseases ,Beijing Children’s Hospital ,Capital Medical University ,Beijing ,China
Liu, Gang;
Affiliation
Key Laboratory of Chemical Biology (Ministry of Education) ,Department of Clinical Pharmacy ,School of Pharmaceutical Sciences ,Cheeloo College of Medicine ,Shandong University ,Jinan ,China
Zhao, Wei

Objective: The decision of vancomycin dosage for central nervous system (CNS) infections is still a challenge because its bactericidal nature in cerebrospinal fluid (CSF) has not been confirmed by human studies. This study systematically reviewed the literatures on vancomycin in patients with meningitis, ventriculitis, and CNS device-associated infections, to assess efficacy, safety, and pharmacokinetics to better serve as a practical reference. Methods: Medline, Embase, and Cochrane Library were searched using terms vancomycin, Glycopeptides, meningitis, and central nervous system infections. Data were extracted including characteristics of participants, causative organism(s), administration, dosage, etc., The clinical response, microbiological response, adverse events and pharmacokinetic parameters were analyzed. Results: Nineteen articles were included. Indications for vancomycin included meningitis, ventriculitis, and intracranial device infections. No serious adverse effects of intravenous (IV) and intraventricular (IVT) vancomycin have been reported. Dosages of IV and IVT vancomycin ranged from 1000–3000 mg/day and 2–20 mg/day. Duration of IV and IVT vancomycin therapy most commonly ranged from 3–27 days and 2–21 days. Therapeutic drug monitoring was conducted in 14 studies. Vancomycin levels in CSF in patients using IV and IVT vancomycin were varied widely from 0.06 to 22.3 mg/L and 2.5–292.9 mg/L. No clear relationships were found between vancomycin CSF levels and efficacy or toxicity. Conclusion: Using vancomycin to treat CNS infections appears effective and safe based on current evidence. However, the optimal regimens are still unclear. Higher quality clinical trials are required to explore the vancomycin disposition within CNS.

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License Holder: Copyright © 2022 Liu, Xiao, Liu, Wu, Qi, Wang, Shen, Liu and Zhao.

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