Intraventricular vancomycin in the treatment of ventriculitis associated with cerebrospinal fluid shunting and drainage.

The results of treatment of 50 cases of ventriculitis associated with the use of cerebrospinal fluid shunts or external ventricular drains, and treated with intraventricular vancomycin, are reported. While the overall cure rate was 66% with four cases lost to follow-up, in those cases where treatment involved shunt removal, 20 mg vancomycin daily intraventricularly, and another appropriate systemic antibiotic, 22 of 24 cases were cured with two cases lost to follow-up. In those cases where the shunt was left in during treatment, results were poor and revision for blockage of the distal catheter of ventriculoperitoneal shunts was required in 44% of these. All five patients whose ventriculitis followed external ventricular drainage were cured. Despite relatively high trough levels of vancomycin in the cerebrospinal fluid, no evidence of toxicity was seen.