6
Treatment
Empiric Antimicrobials
➤ Vancomycin plus an anti-pseudomonal β-lactam (such as cefepime,
ceftazidime or meropenem) is recommended as empiric therapy
for healthcare-associated ventriculitis and meningitis. Choice
of the empiric β-lactam agent should be based on local in vitro
susceptibility patterns (S-L).
➤ In seriously ill adult patients with healthcare-associated ventriculitis
and meningitis, the vancomycin trough concentration should be
maintained at 15–20 μg/mL in those receiving intermittent bolus
administration (S-L).
➤ For patients with healthcare-associated ventriculitis and meningitis
who have experienced anaphylaxis to β-lactam antimicrobial
agents and in whom meropenem is contraindicated, aztreonam or
ciprofloxacin is recommended for gram-negative coverage (S-L).
➤ For patients with healthcare-associated ventriculitis and meningitis
who are colonized or infected elsewhere with a highly antimicrobial-
resistant pathogen, adjusting the empiric regimen to treat for this
pathogen is recommended (S-L).
Specific Antimicrobials
➤ For treatment of infection caused by methicillin-susceptible
Staphylococcus aureus, nafcillin or oxacillin is recommended (S-M).
If the patient cannot receive β-lactam agents, the patient can be
desensitized or may receive vancomycin as an alternative agent (W-M).
➤ For treatment of infection caused by methicillin-resistant S. aureus
(MRSA), vancomycin is recommended as first line therapy (S-M), with
consideration for an alternative antimicrobial agent if the vancomycin
MIC is ≥1 μg/mL (S-M).
➤ For treatment of infection caused by coagulase-negative staphylococci,
the recommended therapy should be similar to S. aureus and based on
in vitro susceptibility testing (S-M).
➤ If the staphylococcal isolate is susceptible to rifampin, this agent
may be considered in combination with other antimicrobial agents
for staphylococcal ventriculitis and meningitis (W-L). Rifampin is
recommended as part of combination therapy for any patient with
intracranial or spinal hardware such as a CSF shunt or drain (S-L).
