Antibiotic Concentrations in Intracranial Pus: A Study from a Collaborative Project

Abstract

The notion of monitoring antibiotic therapy for brain abscess is a relatively unfamiliar one in neurosurgical practice, and there is little information on its value as a guide to therapy. Studies on the penetration of antibiotics into brain tissue are few (Wellman et al., 1953; Ruedy, 1960) and, so far as we are aware, levels of antibiotics in brain abscess cavities have been reported only in one series of six patients (Black et al, 1973). The nature of the blood-brain barrier itself remains a mystery (Eckman et al, 1958) and, although cerebrospinal fluid levels of antibiotics have been measured relative to serum concentration, the gradient between blood and brain tissue has yet to be established for almost all antibiotics. Ancillary to a wider study on the pathogenesis and course of brain abscess, undertaken experimentally and in collaboration with neurosurgeons at nine centres in England and Wales, we have sought to establish reliable methods for the assay of antimicrobial drugs in pus.

The participants are neurological surgeons and microbiologists from the following centres: Atkinson Morley’s Hospital, London; Frenchay Hospital, Bristol; The London Hospital; The National Hospitals for Nervous Diseases London; The Regional Centre for Neurology and Neurosurgery, Old- church Hospital, Essex; Queen Charlotte’s Hospital for Women, London; The Wessex Neurological Centre, Southampton General Hospital; St. Bartholomew’s Hospital London; The University Hospital of Wales, Cardiff; Walton Hospital, Liverpool.