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To the Editor.—
The wide variation in CSF concentration of intrathecally administered aminoglycoside antibiotics may have an explanation other than changing circulation and absorption of the drug, as suggested by Dr Hamory and colleagues (236: 1973, 1976).During repeated lumbar punctures, the CSF often escapes the arachnoid into the subdural space. A second puncture may tap this fluid pool in the subdural space, and there is no way for one to know whether or not the arachnoid membrane has been entered. Injection of a drug under these circumstances results in subdural rather than intraarachnoidal injection. This phenomenon is very well known to myelographers, who can demonstrate it visually.
Messer HD. Intrathecal Aminoglycoside Antibiotic Administration. JAMA. 1977;237(23):2472. doi:10.1001/jama.1977.03270500024014
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