4-Quinolones in the treatment of infections of the central nervous system.

The literature concerning the penetration of new 4-quinolones into the cerebrospinal fluid (CSF) and brain tissue is reviewed as well as the few reports on clinical use of these antibiotics in the treatment of infections of the central nervous system (CNS). Pefloxacin has been found to penetrate well into the CSF of patients with normal or inflamed meninges as well as into brain tissue. Ciprofloxacin also penetrates into CSF, although not as well as pefloxacin. Two patients with meningitis due to Pseudomonas aeruginosa have been reported to have recovered after treatment with ciprofloxacin. Because of the spectrum limitations of quinolones, especially with regard to anaerobes and gram-positive aerobic cocci, these agents should not be considered for empiric use in CNS infections. They may, however, become alternatives in the rare cases of CNS infection caused by organisms resistant to other antibiotics.