Concentration of tazobactam/piperacillin in the Cerebrospinal Fluid of Patients with <i>Haemophilus influenzae</i> Type B Meningitis

  • FUKASAWA Chie
    Division of Infectious Diseases, Chiba Childrenʼs Hospital
  • HOSHINO Tadashi
    Division of Infectious Diseases, Chiba Childrenʼs Hospital
  • KUTSUNA Satoru
    Division of Infectious Diseases, Chiba Childrenʼs Hospital
  • SAWADA Kyoko
    Division of Clinical Laboratory, Chiba Childrenʼs Hospital
  • SATO Hiroko
    Division of Clinical Laboratory, Chiba Childrenʼs Hospital
  • ISHIWADA Naruhiko
    Division of Control and Treatment of Infectious Diseases, Chiba University Hospital

Bibliographic Information

Other Title
  • <i>Haemophilus influenzae</i> type b 髄膜炎における tazobactam/piperacillin の髄液中濃度に関する検討
  • Haemophilus influenzae type b髄膜炎におけるtazobactam/piperacillinの髄液中濃度に関する検討
  • Haemophilus influenzae type b ズイマクエン ニ オケル tazobactam/piperacillin ノ ズイエキ チュウ ノウド ニ カンスル ケントウ
  • [Concentration of tazobactam/piperacillin in the cerebrospinal fluid of patients with Haemophilus influenzae type B meningitis]

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Abstract

While the incidence of Haemophilus influenzae type b (Hib) meningitis is expected to decrease with the widespread use of the Hib vaccine, the resistance of Hib has actually increased. Therefore, selection of the initial antibiotics used for treatment must be performed with resistant bacteria, including β-lactamase negative ampicillin resistant H. influenzae (BLNAR), in mind. Tazobactam/piperacillin (TAZ/PIPC) has a satisfactory minimum inhibitory concentration (MIC) against BLNAR and is a β-lactamase inhibitor. Although there is no insurance coverage for its use in patients with meningitis, the penetration of TAZ/PIPC into cerebrospinal fluid (CSF) in animal experiments promises a satisfactory result, and we have been using a combination of ceftriaxone (CTRX) and TAZ/PIPC as an initial treatment and a resistant bacteria countermeasure in patients with Hib meningitis at our hospital since 2008. We examined the concentration of TAZ/PIPC in CSF to further investigate the possibility of using TAZ/PIPC as an antibiotic treatment against bacterial meningitis. In cases treated with a 1 : 8 drug formulation of TAZ/PIPC against Hib meningitis at our hospital, we used the remaining portion of a CSF sample collected after the initiation of TAZ/PIPC administration and then measured the concentrations of TAZ and PIPC in the CSF. Six specimens from 5 patients between the ages of 6 and 59 months were examined. The dosage of TAZ/PIPC was 95.7-113.6mg/kg/dose×3 times/day, and the CSF concentrations at 0-105 minutes after the completion of the administration were 0.319-1.32μg/mL for TAZ and 2.54-7.74μg/mL for PIPC. With the approved dosage, the peak concentration level during the acute period indicated a sufficient CSF concentration level for the antibacterial and βlactamase inhibition effects against Hib. As an antibiotic treatment for H. influenzae meningitis, the combined usage of TAZ/PIPC is likely to be effective as a resistant bacteria countermeasure, in addition to thirdgeneration cephem drugs and meropenem.

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 87 (5), 590-595, 2013

    The Japanese Association for Infectious Diseases

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