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October 25, 1976

Intrathecal Amikacin Administration: Use in the Treatment of Gentamicin-Resistant Klebsiella pneumoniae Meningitis

Author Affiliations

From the departments of medicine (Drs Hamory and Sande) and neurosurgery (Dr Ignatiadis), the University of Virginia School of Medicine, Charlottesville.

JAMA. 1976;236(17):1973-1974. doi:10.1001/jama.1976.03270180049022

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.1,2 Penetration 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-resistant Klebsiella 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 using Bacillus subtilis (American Type Culture Collection) as the