Neurocritical Care

Recommended in adult patients with cerebral spinal fluid (CSF) shunt or ventriculostomy infections for

difficult-to-eradicate pathogens or for patients who cannot undergo the surgical component of therapy

antimicrobial therapy alone (Clin Inf Dis 2017;64:e34-65)

Not recommended for neonatal or infant central nervous system (CNS) infection

Preservative-free formulations

containing dextrose, whenever possible because of potential osmolality concerns

Do not use medications known to lower the seizure threshold (e.g., β-lactams).

pH similar to the CSF when possible (7.27–7.37).

Total volume ideally less than or equal to 3 mL

Intravenous plus intraventricular is recommended.

external ventricular drain

After drug instillation, the ventriculostomy tubing should be clamped for at least 15 minutes to allow

the medication to equilibrate in the CSF before reopening the drain. Patients with high intracranial

pressure may not tolerate this, so the ventriculostomy should be clamped for as long as the patient can

tolerate, with close monitoring of the ICP.

Antimicrobial

Daily Dose/Volume

(adults)

Approximate

Osmolality (mOsm/kg)

Common Adverse Effects

Vancomycin

10–20 mg/1 mL of NS

Headache, mental status changes,

possible hyponatremia

Gentamicin

4–8 mg/1 mL of NS

Seizures

Tobramycin

4–8 mg/1 mL of NS

Seizures

Amikacin

30 mg/1 mL of NS

Seizures

Polymyxin B

5 mg/1 mL of NS

Hypotonia, seizures, meningeal

inflammation

Colistimethate

10 mg/3 mL of NS

Meningeal inflammation

Amphotericin B

deoxycholate

0.5 mg/3 mL of SWI

256 (in dextrose 5%)

Nausea, vomiting

Daptomycin

5 mg/2 mL of NS

Unknown

NS = normal saline; SWI = sterile water for injection.

TA, et al. Intraventricular daptomycin and intravenous linezolid for the treatment of external ventricular-drain-associated ventriculitis due to vancomycin-resistant