PHRM 311 Lecture Notes - Lecture 14: Competitive Inhibition, Spinal Anaesthesia, Vancomycin
Document Summary
Special aspects of pk for the brain (part 3) Drugs that don"t normally get into the brain but have to. The mortality rate of untreated disease approaches 100% there is high failure (mortality) rate even with good, timely therapy. This is a clear issue of how to penetrate the brain to kill the bacteria. The preferred approach is antimicrobial therapy , along with dexamethasone. Since the csf is a site of impaired immunity (antibodies cannot get in to the brain either), a fundamental principle of therapy of bacterial meningitis is that antimicrobial agents must achieve a bactericidal effect within csf. Concentrations high enough only to be bacteriostatic are no good. Antimicrobial penetration into csf is fairly poor when the bbb is normal, so most beta-lactam agents (e. g. penicillin) have limited use. However, in the presence of meningeal inflammation caused by infection, csf penetration is enhanced. This is believed to be a result of:
