Abstract Thirteen of 29 patients with meningitis had a complicating ventriculitis (white blood cell count > 200/cu mm or positive ventricular fluid culture), including eight of 12 neonates. Ventriculitis should be considered a brain abscess and treated with the direct instillation of antibiotics. Periodic irrigation and drainage may be necessary. Very high antibiotic levels can be obtained in the ventricular fluid using the recommended dose schedule. A Salmon-Rickham ventriculostomy reservoir was placed in the lateral ventricle to obviate repeated puncture of the brain. Seven of ten patients with ventriculitis given antibiotics intraventricularly and systemically are normal including four of six neonates. The ratio of head circumference to cerebral mantle is used as a rough estimate of the ventricular fluid volume to aid in selecting the proper antibiotic dose. References 1. Overall JC: Neonatal bacterial meningitis: Analysis of predisposing factors and outcome compared with matched control subjects . J Pediat 76:499-511, 1970.Crossref 2. Sproles ET, Azerrad J, Williamson C, et al: Meningitis due to Hemophilus influenzae: Long term sequelae . J Pediat 75:782-788, 1969.Crossref 3. Wehrle PF, Mathies AW, Leedom JM, et al: Bacterial meningitis . Ann NY Acad Sci 145:488-498, 1967.Crossref 4. Lorber J, Kalhan SC, Mahgrefte B: Treatment of ventriculitis with gentamicin and cloxacillin in infants born with spina bifida . Arch Dis Child 45:178-185, 1970.Crossref 5. Salmon JH: Puncture porencephaly . Amer J Dis Child 114:72-79, 1967.Crossref 6. Salmon JH: Isolated unilateral hydrocephalus following ventriculoatrial shunt . J Neurosurg 32:219-226, 1970.Crossref 7. Witorsch P, William TW Jr, Ommaya AK, et al: Intraventricular administration of amphotericin B . JAMA 194:699-702, 1965.Crossref 8. Kramer PW, Griffith RS, Campbell RL: Antibiotic penetration of the brain: A comparative study . J Neurosurg 31:295-302, 1969.Crossref 9. Resnick GE, Corbin D, Sandberg DH: Determination of serum chloramphenicol utilizing gas-liquid chromatography and electron capture spectrometry . Anal Chem 38:582-585, 1966.Crossref 10. Grove DC, Randall WA: Assay methods of antibiotics: A laboratory manual . Antibiotics Monographs No. 2, New York, Medical Encyclopedia, 1955, pp 14-16. 11. Hamburger M, Garancis JC, Scott NJ, et al: Studies in experimental staphylococcal endocarditis in dogs: V. Treatment with oxacillin . J Lab Clin Med 70:786-799, 1967. 12. Bering EA: Circulation of the cerebrospinal fluid . J Neurosurg 19:405-413, 1962.Crossref 13. Berman PH, Banker BQ: Neonatal meningitis: A clinical and pathological study of 29 cases . Pediatrics 38:6-24, 1966.
American Journal of Diseases of Children – American Medical Association
Published: Jul 1, 1972