Vanco and different disease states

 Q: Inflammation of meninges _________________ the penetration of Vancomycin in Cerebrospinal Fluid (CSF)  (select one)

A) increases

B) decreases

Answer: A

Although vancomycin has limited penetration in CSF, it gets improved when the meninges are inflamed. This makes vancomycin a good choice in MRSA meningitis. Although some experts argue this claim. Daptomycin does not have this advantage. 

The objective of this question is to highlight the complex pharmacokinetics of commonly used drugs in ICU under various clinical conditions - like, diabetic patients do not respond well to vancomycin due to compromised soft tissue penetration. Also, contrary to popular belief, the penetration of vancomycin in lung tissues is limited. It requires four times higher serum levels to penetrate the lung tissues.

#pharmacology

References:

1. Taheri M, Dadashzadeh S, Shokouhi S, Ebrahimzadeh K, Sadeghi M, Sahraei Z. Administration of Vancomycin at High Doses in Patients with Post Neurosurgical Meningitis: A Comprehensive Comparison between Continuous Infusion and Intermittent Infusion. Iran J Pharm Res. 2018;17(Suppl2):195-205. 

2. Roman Mounier & et. al World Neurosurgery Is First-Line Vancomycin Still the Best Option to Treat Staphylococcus Health Care–Associated Meningitis? World Neurosurgery Volume 99, March 2017, Pages 812.e1-812.e5 

3. Skhirtladze K, Hutschala D, Fleck T, et al. Impaired target site penetration of vancomycin in diabetic patients following cardiac surgery. Antimicrob Agents Chemother 2006; 50:1372. 

4. Cruciani M, Gatti G, Lazzarini L, et al. Penetration of vancomycin into human lung tissue. J Antimicrob Chemother 1996; 38:865.