Intrathecal Amikacin Administration

GRAM-NEGATIVE organisms resistant to gentamicin sulfate have recently emerged as a major cause of hospital-acquired infections. Amikacin sulfate, a semisynthetic derivative of kanamycin sulfate, is a new aminoglycoside with a wide spectrum of antibacterial activity against such organisms.1,2Penetration of this drug into the cerebrospinal fluid (CSF) is poor, and like other aminoglycosides, adequate drug concentrations usually cannot be achieved by parenteral administration alone. This case illustrates the first successful use of amikacin administered intrathecally and intramuscularly in a patient with posttraumatic meningitis caused by a gentamicin-resistantKlebsiella pneumoniae. Materials and Methods Cerebrospinal fluid was obtained by lumbar puncture. Culture specimens were obtained from the wound at operation. Both were plated on chocolate and blood agar plates, and isolates were identified by the method of Edward and Ewing. Serum and CSF drug levels were determined by the agar well-diffusion method usingBacillus subtilis(American Type Culture Collection) as the