Ceftazidime-Avibactam for CNS Infections

CNS Penetration Characteristics

The penetration of ceftazidime-avibactam is considerably higher than traditional agents like vancomycin and comparable to linezolid, with CSF/serum concentration ratios of 0.35-0.59 for ceftazidime and 0.51-0.57 for avibactam, as recommended by the Infectious Diseases Society of America 1

Meropenem has traditionally been the drug of choice for nosocomial meningitis and ventriculitis, particularly for gram-negative infections, according to the Society of Critical Care Medicine 2
Colistin has poor CNS penetration even with inflamed meninges, often requiring intrathecal or intraventricular administration in addition to systemic therapy, as stated by the European Society of Clinical Microbiology and Infectious Diseases 2
For OXA-48-like producing carbapenem-resistant Enterobacterales infections, ceftazidime-avibactam is recommended as first-line treatment, including for CNS infections, by the European Society of Clinical Microbiology and Infectious Diseases 3

Therapeutic drug monitoring is recommended when treating CNS infections with ceftazidime-avibactam, with sampling of both blood and CSF when possible, as suggested by the American Society of Health-System Pharmacists 4

For nosocomial meningitis/ventriculitis, a 21-day course of antimicrobial therapy is generally recommended by the Infectious Diseases Society of America 2
Monitoring of CSF sterilization through repeated cultures can help tailor the duration of therapy, as recommended by the Society of Critical Care Medicine 2
Surgical drainage of focal abscesses and removal of any foreign body should be performed whenever possible to improve treatment outcomes, as advised by the Infectious Diseases Society of America 1