316
Letters to the Editor
Warning about using cephalothin with central nervous system infections
The Journal of Pediatrics February 1975
4.
Weinstein L, and Kaplan K: The cephalosporins: Microbiological chemical and pharmacological properties and use in chemotherapy of infection, Ann Intern Med 72:729, 1970.
To the Editor." The recent review of antimicrobial therapy by Drs. McCracken and Eichenwald I is a valuable concise compilation of current knowledge in this field. The paper will undoubtedly be used as a ready reference source by pediatric residents and practitioners for some time in the future. I would like to point out a potential source of error in Table I of the article, which outlines preferred antimicrobial therapy of specific bacterial pathogens. Staphylococcus epidermidis, listed as causing bacteremia or ventriculitis, is assigned penicillin as the drug of choice with cephalothin as the alternate acceptable drug. Actually, in the case of a child with ventriculitis caused by Staphylococcus epidermidis, a situation not uncommon after surgical correction of various congenital neuroanatomic defects, cephalothin would be an unacceptable drug to use. As Drs. McCracken and Eichenwald correctly point out later in their article, 2 cephalothin appears in spinal fluid in inadequate amounts to permit its use in the treatment of any form of meningitis. Poor central nervous system penetration by cephalothin was demonstrated by Vianna and Kaye 3 in patients with and without meningitis. The inadequacy of cephalothin in treating central nervous system infections was again underscored by Weinstein and Kaplan4in a review of the clinical usefulness of the drug. Francis J. Crosson, Jr., M.D. National Naval Medical Center Bethesda, Md. 20014
REFERENCES 1.
McCracken GH, and Eichenwald HF: Antimicrobial therapy: Therapeutic recommendations and a review of newer drugs, Part I. Therapy of infectious conditions, J PEDIATR 85:297, 1974. 2. McCracken GH, and Eichenwald HF: Antimicrobial therapy: Therapeutic recommendations and a review of newer drugs, Part II. The clinical pharmacology of the newer antimicrobial drugs, J PED1ATR85:451, 1974. 3. Vianna N J, and Kaye D: Penetration of cephalothin into the spinal fluid, Am J Med Sci 254:216, 1967.
Reply To the Editor: Doctor Crosson is correct in stating that the cephalosporin antibiotics should never be used for therapy of central nervous system infections. Our listing of cephalothin as an alternative for infections caused by Staphylococcus epidermidis is applicable only for non-central nervous system disease in patients either allergic to penicillin or infected with penicillin-resistant strain. S. epidermidis is frequently associated with infection of cerebrospinal fluid shunts. This usually saprophytic organism may be resistant to penicillin and, on occasion, resistant to methicillin also. Therapy of shunt infections caused by S. epidermidis must be guided by in vitro susceptibility studies. Initial therapy is based on local experience with the organism and includes parenteral therapy with penicillin or methicillin plus intraventricular therapy administered through a reservoir. Gentamicin (1 or 2 mg daily) or methicillin (10 to 30 mg daily) is safe and effective when administered intraventricularly. Combined parenteral plus intrareservoir therapy is successful in approximately one-half of patients. Complete shunt replacement is necessary if antibiotic therapy alone fails. We are grateful to Doctor Crosson for pointing out this error in our paper. George H. McCracken, Jr., M.D. Associate Professor of Pediatrics University of Texas Health Science Center at Dallas Southwestern Medical School 5323 Harry Hines Blvd. Dallas, Texas 75235 Heinz F. Eichenwald, M.D. Professor and Chairman Department of Pediatrics University of Texas Health Science Center at Dallas Southwestern Medical School
Letters to the Editor
Warning about using cephalothin with central nervous system infections
The Journal of Pediatrics February 1975
4.
Weinstein L, and Kaplan K: The cephalosporins: Microbiological chemical and pharmacological properties and use in chemotherapy of infection, Ann Intern Med 72:729, 1970.
To the Editor." The recent review of antimicrobial therapy by Drs. McCracken and Eichenwald I is a valuable concise compilation of current knowledge in this field. The paper will undoubtedly be used as a ready reference source by pediatric residents and practitioners for some time in the future. I would like to point out a potential source of error in Table I of the article, which outlines preferred antimicrobial therapy of specific bacterial pathogens. Staphylococcus epidermidis, listed as causing bacteremia or ventriculitis, is assigned penicillin as the drug of choice with cephalothin as the alternate acceptable drug. Actually, in the case of a child with ventriculitis caused by Staphylococcus epidermidis, a situation not uncommon after surgical correction of various congenital neuroanatomic defects, cephalothin would be an unacceptable drug to use. As Drs. McCracken and Eichenwald correctly point out later in their article, 2 cephalothin appears in spinal fluid in inadequate amounts to permit its use in the treatment of any form of meningitis. Poor central nervous system penetration by cephalothin was demonstrated by Vianna and Kaye 3 in patients with and without meningitis. The inadequacy of cephalothin in treating central nervous system infections was again underscored by Weinstein and Kaplan4in a review of the clinical usefulness of the drug. Francis J. Crosson, Jr., M.D. National Naval Medical Center Bethesda, Md. 20014
REFERENCES 1.
McCracken GH, and Eichenwald HF: Antimicrobial therapy: Therapeutic recommendations and a review of newer drugs, Part I. Therapy of infectious conditions, J PEDIATR 85:297, 1974. 2. McCracken GH, and Eichenwald HF: Antimicrobial therapy: Therapeutic recommendations and a review of newer drugs, Part II. The clinical pharmacology of the newer antimicrobial drugs, J PED1ATR85:451, 1974. 3. Vianna N J, and Kaye D: Penetration of cephalothin into the spinal fluid, Am J Med Sci 254:216, 1967.
Reply To the Editor: Doctor Crosson is correct in stating that the cephalosporin antibiotics should never be used for therapy of central nervous system infections. Our listing of cephalothin as an alternative for infections caused by Staphylococcus epidermidis is applicable only for non-central nervous system disease in patients either allergic to penicillin or infected with penicillin-resistant strain. S. epidermidis is frequently associated with infection of cerebrospinal fluid shunts. This usually saprophytic organism may be resistant to penicillin and, on occasion, resistant to methicillin also. Therapy of shunt infections caused by S. epidermidis must be guided by in vitro susceptibility studies. Initial therapy is based on local experience with the organism and includes parenteral therapy with penicillin or methicillin plus intraventricular therapy administered through a reservoir. Gentamicin (1 or 2 mg daily) or methicillin (10 to 30 mg daily) is safe and effective when administered intraventricularly. Combined parenteral plus intrareservoir therapy is successful in approximately one-half of patients. Complete shunt replacement is necessary if antibiotic therapy alone fails. We are grateful to Doctor Crosson for pointing out this error in our paper. George H. McCracken, Jr., M.D. Associate Professor of Pediatrics University of Texas Health Science Center at Dallas Southwestern Medical School 5323 Harry Hines Blvd. Dallas, Texas 75235 Heinz F. Eichenwald, M.D. Professor and Chairman Department of Pediatrics University of Texas Health Science Center at Dallas Southwestern Medical School
