Intraventricular antibiotics for bacterial meningitis in neonates

Infection of the membranes and the fluid surrounding the brain (meningitis) and of the fluid filled spaces in the brain (ventriculitis) may be caused by bacteria, especially gram negative bacteria. This type of infection is difficult to eradicate using safe doses of antibiotics given into the blood stream. In theory, intraventricular administration of antibiotics (administration of antibiotics into the fluid filled spaces in the centre of the brain) would produce higher antibiotic concentrations in the fluid in the brain than intravenous administration alone, and eliminate the bacteria more quickly. However, taps of the fluid filled spaces may cause harm as the needle has to penetrate the brain tissue. Only one trial was identified. In this trial enrolling infants with gram negative meningitis and ventriculitis, the use of intraventricular antibiotics in addition to intravenous antibiotics resulted in a 3 fold increased risk for mortality compared to standard treatment with intravenous antibiotics alone. Based on this result, intraventricular antibiotics should be avoided. Further trials comparing these interventions are not justified in newborn infants.