The Penetration of Penicillin through Normal and Inflamed Meninges

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Abstract
In more than 20 patients without meningeal involvement who were given intramusc. injns. of 10,000-25,000 units of penicillin every 3 hrs., penicillin was not found in the spinal fluid in a single case alter 5-8 days of therapy. In 5 patients with meningococcemia without meningitis who received 25,000 units of penicillin intramusc. every 3 hrs., and in 1 who was given 40,000 units on the same schedule, penicillin was not found in the spinal fluid in any case after 8 and 24 hrs. of therapy in 5 cases, and after 5 and 9 days in 1 case. In 2 patients with tuberculous meningitis who were treated extrathecally alone, only a trace of penicillin could be found in the spinal fluid. In 9 patients with meningococcal meningitis who were treated with penicillin extrathecally only, the appearance of penicillin in the spinal fluid was irregular and inconstant. Amounts were never larger than 0.05 u/ml. It is believed that penicillin penetrates the meningeal barrier too erratically to justify its use extrathecally alone in purulent meningitis.