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Parenteral Drug Administration: Routes of Administration and Devices
Published in Sandeep Nema, John D. Ludwig, Parenteral Medications, 2019
Himanshu Bhattacharjee, Vivian Loveless, Laura A. Thoma
Here, the drug product is injected or infused directly into the lateral ventricles of the brain. This route is employed mainly in the treatment of infections (such as bacterial or fungal meningitis and/or ventriculitis) or malignancies (such as leukemic infiltrates of the meninges or carcinomatoses) involving the membranes and cerebrospinal fluid surrounding the CNS. It is used especially in situations where the drugs involved are known to diffuse or pass poorly from the vascular compartment into the ventricles and subarachnoid space and/or where reduction of systemic side effects from a particular agent is desired. One such example is the treatment of fungal meningitis with amphotericin B13 or in the therapy of leukemic infiltrates with methotrexate.14 Often, therapy via this route is complemented by the IV administration of the same agent which has been injected into the ventricles.
The Risks of Silver Nanoparticles to the Human Body
Published in Huiliang Cao, Silver Nanoparticles for Antibacterial Devices, 2017
Krzysztof Siemianowicz, Wirginia Likus
Neurosurgical catheters used for draining an excess of cerebrospinal fluid (CSF) can be used as a fully implanted device to drain CSF into the peritoneal cavity or as a temporary external drainage. In both cases, catheters are prone to bacterial infections, which can lead to very serious consequences such as meningitis, inflammation of the ventricles of brain (catheter-associated ventriculitis) or brain abscess. Nanosilver has been introduced into everyday neurosurgical usage because of its antibacterial properties (Bayston et al. 2007; Galiano et al. 2008; Lackner et al. 2008).
Mechanical filtration of the cerebrospinal fluid: procedures, systems, and applications
Published in Expert Review of Medical Devices, 2023
Although the management of bacterial meningoencephalitis (BME) has improved and survival rates increased, the mortality rate of acute meningitis remains significant. BME in adults is commonly caused by Streptococcus pneumoniae (pneumococcus) or Neisseria meningitides (meningococcus). Escherichia coli and Staphylococcus species account for a small number of cases, while Haemophilus influenzae occurs mainly in children. Tuberculous meningitis may present at any age, while BME by Listeria monocytogenes predominantly affects neonates and the elderly. Pseudomonas, Acinetobacter, and Klebsiella are three multidrug-resistant (MDR) that can cause gram-negative bacterial meningitis (GBM) in patients admitted to hospitals or nursing homes, particularly if they happen to have implanted devices. Within this group, ventriculomeningitis (VM), is a nosocomial infection with high mortality and morbidity following central nervous system surgery and drainage catheters [11,12]. Increasingly antibiotic-resistant bacteria strains cause high mortality even under the best antibiotic standards; therefore, complementary therapies are needed to improve outcomes. While IT/IVT routes of antibiotic administration are not generally considered the first option for the treatment of BME [12,13], they might be an option to consider in MDR GBM BME that does not respond to IV regimens. As IT/IVT antibiotics can bypass the blood–brain barrier, obtain a more effective antibiotic concentration in CSF, and reduce systemic side effects. In this context, a combination of IV/IVT antibiotics with CSF filtration may be an additional option. The feasibility of CSF filtration for MDR GBM has been shown, and system parameters have been characterized for bacterial, endotoxin, and cytokine clearance [14]. Meanwhile, pyogenic ventriculitis (PV) is a serious situation, often a part of the community-acquired BME syndrome due to inflammation of the ventricular ependymal lining with the presence of pus in the ventricular system. Again, IT delivery of antibiotics remains an option for adjunctive therapy to IV antibiotics when the latter fails to sterilize the CSF in PV. In this context, the combination of IT antibiotics with CSF exchange with physiological fluid showed a beneficial impact in two cases of PV. This treatment was part of a bundle approach that additionally included corticosteroid treatment and regular patient rotation [15].