TiHo Bibliothek elib - Tierärztliche Hochschule Hannover

Falldarstellung
Besides the previous considerations of molecular size, lipophilicity, and plasma
protein binding in choosing an appropriate medication, the degree of inflammation
should also be taken into account.
The majority of drugs are removed from the CSF compartment by energydependent,
active mechanisms and different medications have variable affinity to
these transport systems. The specific transport systems may be inhibited during
meningitis (Spector and Lorenzo 1974) and drugs reach a higher concentration within
the CNS.
Broad-spectrum antibiotic coverage should be implemented where cultures cannot
be obtained or the culture remains negative despite strong suspicion of bacterial
participation. Previous reports recommend IV broad-spectrum antibiotics such as
ampicillin (5 - 22 mg/kg, IV, q 6 hrs) in combination with chloramphenicol (10 - 15
mg/kg, PO, q 6 hrs) or metronidazole (10 - 15 mg/kg, PO, q 8 hrs) (Fenner 1998; Vite
2005). Chloramphenicol was the BA standard therapy because of its broad
antimicrobial spectrum and effective blood- brain- barrier (BBB) penetration.
However, it`s lack of bactericidal activity and side effects, make it less attractive for
first-line therapy. More recent recommendations incorporate third generation
cephalosporins for gram- negative and gram- positive bacteria, metronidazole for
anaerobes, and ampicillin for additional gram- positive coverage (Kent 2006;
Bilderback and Faissler 2009).
In addition to antimicrobials, medication for decreasing intracranial pressure (ICP)
and edema should be included in the treatment plan. Mannitol is an important part in
the medical management of elevated ICP (Plumb 1999). In this study, it was
administered at a dosage of 258.6 mg/kg IV once. As an osmotic diuretic it shifts
water from intracellular and interstitial spaces into the vasculature reducing the ICP
and edema (Plumb 1999). Furthermore, it is considered a free radical scavenger
which can reduce inflammatory by-products leading to a better recovery in ischemic
brain conditions (Marcoux and Choi 2002).
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