Cerebrospinal fluid penetration of tigecycline

摘要

We report, in a clinical setting, the tigecycline concentration and area under the concentration-time curve (AUC) - both in blood and in cerebrospinal fluid (CSF) - of a patient with a ventriculo-atrial shunt infection. Tigecycline weakly penetrates CSF the CSF-to-serum concentration ratio was 0.079 and CSF-to-serum AUC_(0-12) ratio was 0.067. Tigecycline is a synthetic derivate of minocycline and belongs to the glycylcycline class of antibiotics. Tigecycline has an expanded broad-spectrum activity against Gram-positive and Gram-negative bacteria, including multidrug-resistant strains (vancomycin-resistant enterococci, methicillin-resistant staphylo-cocci, and Acinetobacter baumannii) [1]. Due to its scarce bioavailability after oral administration, the drug is usually administered as a 30-60-min intravenous (IV) infusion [2]. The half-life of tigecycline ranges between 16 and 67 h [1-3]. The drug is mainly excreted unchanged in the faeces and its dosage does not need adjustment in the case of renal failure [2]. Tigecycline is rapidly distributed into the tissues and becomes concentrated primarily in the bile and in the bowel [3,4] and, to a lesser extent, in the lungs [3]. Data regarding the ability of tigecycline to penetrate bone tissue are conflicting, especially between the murine model [5] and the human model [3]. Furthermore, easily comparable data on the ability of the drug to penetrate the central nervous system are lacking [3,4,6].