Журнал «Медицина неотложных состояний» 1 (64) 2015

Despite the large number of antibiotics, antibiotic use modern circuits according to different authors in recent years purulent meningoencephalitis mortality increased to 21-34% and 40-60% is, despite the use of different-spectrum antibiotics [7,10,11] .

One reason for the unsatisfactory outcome of treatment is no possibility of creating an effective concentration of the drug directly into the source of infection for traditional (intravenous, oral) routes of administration. Reducing the concentration is by reducing the volume of blood circulation in the affected area and partial inactivation of the drug in the distribution in organs and tissues. The protective properties of the blood-brain barrier and lead to a significant decline. In our opinion, a possible way to overcome this problem is to intrathecal administration antibacterial drugs.

In the available scientific literature, we found only successful message intrathecal use of levofloxacin in the treatment of multidrug-tuberculosis meningoencephalitis in a 25-year-old HIV-negative patient [12].

Our previous studies on animals have established the safety of intrathecal administration of levofloxacin [2], which led to a clinical stage.

Objective: To investigate the difference levofloxacin concentrations in cerebrospinal fluid and combined with intravenous (IV + intrathecal) routes of administration.

Materials and Methods: The study was conducted in the treatment of 10 HIV-negative patients aged 26 to 60 years (7 men and 3 rd women) with bacterial meningoencephalitis, including 2 patients with tuberculosis meningoencephalitis.

Sampling CSF for the first (before intrathecal therapy) measuring the concentration of levofloxacin treated at least 48 hours after intravenous levofloxacin 500 mg dose in * 2p / day. Conducted lumbar puncture at L3 - L4 and 0.5-1.0 ml were collected. CSF samples. After that intrathecally administered 15 mg. Levofloxacin and 8 mg. dexamethasone. Sampling for the second CSF concentration measurement behaved in the same patient one day after intrathecal administration of levofloxacin.

Studies to determine the concentrations of levofloxacin in CSF held by reversed-phase high-performance liquid chromatography with ultraviolet detection.

Results

Levofloxacin concentrations in cerebrospinal fluid after intrathecal administration in almost all cases higher than the previous level (before intrathecal administration).

The amount of sign changes ranks W = 43, for n = 9. the level of significance p <0.02 using Wilcoxon test.

The results show a statistically significant increase in the concentration of levofloxacin in cerebrospinal fluid of patients even a day after intrathecal administration of 15 mg. drug. It is logical to assume that after administration of levofloxacin concentrations in cerebrospinal fluid was even higher.

Summary

1. Intrathecal administration of 15 mg. levofloxacin with of 8 mg .dexamethasone is safe.

2. Intrathecal administration of 15 mg. levofloxacin. with of 8 mg dexamethasone in combination with intravenous drug leads to a statistically significant increase in cerebrospinal fluid concentrations of levofloxacin at least the day after the injection.

3. Iintrathecal administration of levofloxacin with dexamethasone in the proposed doses can be recommended for the treatment of bacterial meningoencephalitis caused by microorganisms susceptible to levofloxacin.

4. In the event of empirical treatment of bacterial meningoencephalitis intravenous levofloxacin, to improve efficiency and prevention of antibiotic treatment recommended additions intrathecally levofloxacin with dexamethasone in the proposed doses.