45-Pharmacokinetic Evaluation of Cefazolin in the Cerebral Spinal Fluid of Critically Ill Patients
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Pharmacology, Neuroscience, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Alison R. Novak

Introduction/Hypothesis: Recent studies have shown that cefazolin is at least as effective as oxacillin or nafcillin for the treatment of severe methicillin-susceptible Staphylococcus aureus infections and may have a better safety profile. However, the ability of this agent to achieve appropriate therapeutic concentrations in the cerebrospinal fluid (CSF) remains unknown. This study evaluated cefazolin concentrations in the CSF using human waste of drained CSF and excess blood from clinical lab draws.

Methods: This was a prospective pharmacokinetic evaluation of cefazolin following an external ventricular drain (EVD) placement. Patients who received cefazolin with an EVD aged 18 years or older between September 1st, 2019 and March 1st, 2020 were evaluated. Serial plasma and CSF samples were obtained at up to three time points within a dosing interval for analysis. Cefazolin concentrations were determined utilizing LC-MS/MS. Pharmacokinetic parameters were compared over time.

Results: This study enrolled 15 patients with a median age of 56 [51,60], 80% of patients were female, 66.7% white, with a mean creatinine clearance of 126.4 ± 69.7 mL/min and a mean EVD output in 24 hours of 109.4 ± 50.0 mL. The dose of cefazolin was standard at two grams dosed every eight hours, adjusted in both dose and frequency for renal function in two of the fifteen patients. The peak analyzed concentration of cefazolin in the CSF was 5.72 mcg/mL and the trough CSF concentration measured was 0.78 mcg/mL.

Conclusions: Intermittent cefazolin doses achieved concentrations in the CSF for all of the patients treated with cefazolin as a prophylactic agent. Although these patients did not have active documented CNS infections at the time of measurement, cefazolin CSF penetration suggests it may be a reasonable treatment option for CNS infections at commonly prescribed doses depending on organism MIC.


Meta Tag
Content Type Presentation
Knowledge Area Pharmacology
Knowledge Area Neuroscience
Knowledge Level Advanced
Membership Level Select
Tag Cerebrospinal Fluid
Tag Antibiotics
Year 2021
Allison Novak
pharmacokinetic evaluation
cerebral spinal fluid
critically ill patients


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