Cerebrospinal fluid human immunodeficiency virus type 1 (HIV-1) suppression and efavirenz drug concentrations in HIV-1-infected patients receiving combination therapy

Efavirenz, a potent inhibitor of human immunodeficiency virus type 1 (HIV-1) reverse transcriptase, is a promising addition to the antiretroviral armamentarium. Efavirenz levels and HIV-1 RNA levels were measured in cerebrospinal fluid (CSF) and plasma of 10 HIV-1-infected patients taking efavirenz, 600 mg daily, in combination with other antiretroviral medications. Efavirenz was detected in the CSF at a mean concentration of 35.1 nM (range, 6. 6-58.9 nM), which was above the IC95 for wild-type HIV-1. The mean CSF-to-plasma ratio was 0.61% (range, 0.26%-0.99%). CSF HIV-1 RNA levels were ascertained in 9 of the patients; all were <400 copies/mL after a mean of 26 weeks on therapy. Eight of the 9 patients had no detectable virus in plasma. These results indicate that efavirenz is present in the CSF at low levels and is effective in suppressing CSF viral levels when used in combination therapy.

Diffusion of ofloxacin into the cerebrospinal fluid in patients with bacterial meningitis

Ofloxacin diffusion into cerebrospinal fluid (CSF) was evaluated in nine patients with bacterial meningitis. Patients were under treatment with i.v. amoxicillin (100 mg/kg/day), and during the first five days they were also given oral ofloxacin, 200 mg b.i.d. On days 2 and 5, blood and CSF samples were collected for assays by both HPLC and microbiological techniques. Samples were obtained 2 h (n = 2), 4 h (n = 1), 6 h (n = 2), 8 h (n = 2) and 12 h (n = 2) after the ofloxacin dose respectively. Concentration in CSF was 50 to 60% of that in serum and there was no significant difference between results with the two assay techniques.

Study of the cerebrospinal fluid penetrability of ofloxacin

In patients with different neurological diseases with blood-brain barrier dysfunction subjected to diagnostic CSF-tap, simultaneous determinations of ofloxacin concentrations in serum and in CSF were carried out. The results show that ofloxacin penetrates well into the CSF achieving adequate bactericidal concentrations against most of the common causative pathogens of meningitis.