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Intrathecal Amikacin for the Treatment of Pseudomonal Meningitis

Medical Intensive Care Unit Clinical Pharmacy Specialist, Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI

Kathryn B Weber, PharmD

Critical Care Pharmacy Practice Resident, Department of Pharmacy Services, Henry Ford Hospital

Christopher R Zimmerman, PharmD

Clinical Pharmacy Manager, Department of Pharmacy Services, Henry Ford Hospital

Reprints: Kimberly A Corpus PharmD, Department of Pharmacy Services, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202-2689, fax 313/916-1302, kcorpus1{at}hfhs.org

OBJECTIVE: To report a case of gram-negative bacillary meningitis (GNBM) secondary to multidrug-resistant Pseudomonas aeruginosa that was treated with intravenous meropenem and intrathecal and intravenous amikacin.

CASE SUMMARY: A 76-year-old Arabic woman with previous placement of an extraventricular device developed meningitis secondary to P. aeruginosa as a result of a previous pneumonia. The patient was treated with intravenous meropenem and amikacin, with the addition of intrathecal amikacin, until cerebrospinal cultures remained negative for 18 days. She did not experience any adverse effects as a result of the administration of the intrathecal amikacin. Although the meningitis subsequently resolved, the patient eventually died due to Candida glabrata fungemia.

DISCUSSION: Dual therapy is recommended for patients with P. aeruginosa meningitis. In our patient, the increasing resistance to imipenem and resistance to all other potential antibiotics resulted in the use of an alternative administration technique that has not been well documented in recent literature.

CONCLUSIONS: In patients who have GNBM due to P. aeruginosa, the combination of intrathecal and intravenous amikacin may be an option for therapy, especially when clinical options are limited by resistance, severity of illness, and location of the infection. More information is required and further study is needed on this topic.

Key Words: amikacin, intrathecal administration, meningitis, neurosurgery, Pseudomonas aeruginosa

Published Online, April 30, 2004. www.theannals.com, DOI 10.1345/aph.1D541