Different intra-cerebrospinal distribution of linezolid in patients with inflammatory meningitis.

Abstract

Linezolid has excellent antibiotic activity against gram-positive organisms and is expected to be an alternative to vancomycin for the treatment of bacterial meningitis. Although accumulated evidence has shown the superior pharmacokinetic characteristics of linezolid to vancomycin, such as cerebrospinal fluid penetration, in the treatment of meningitis, pharmacokinetic information regarding the intra-cerebrospinal distribution of linezolid and the effects of drainage on the linezolid concentration in the cerebrospinal fluid are unclear. In our experienced two cases, the linezolid concentrations in the cerebrospinal fluid were in the following order: subarachnoid space (cisternal drainage and lumbar puncture) ≥ third ventricle > lateral ventricle. In addition, the linezolid concentration in the cerebrospinal fluid, collected via lumbar puncture, tended to increase after removal of drainage. This is a first report to present two cases of meningitis that showed different intra-cerebrospinal distribution of linezolid in various parts of the central nervous system and increased linezolid concentration in the cerebrospinal fluid after removal of drainage.