14
Treatment
Table 3. Recommended Dosages of Antimicrobial Agents
Administered by the Intraventricular Route
Antimicrobial Agent Daily Intraventricular Dose
Amikacin
5–50 mg
a
Amphotericin B deoxycholate
b
0.01–0.5 mg in 2 ml of 5% dextrose in water
Colistin (formulated as colistimethate
sodium)
10 mg
Daptomycin
2–5 mg
c
Gentamicin
1–8 mg
d,e,f
Polymyxin B
5 mg
g
Quinupristin/dalfopristin 2–5 mg
Tobramycin 5–20 mg
Vancomycin
5–20 mg
e,f,h
ere are no specific data that define the exact dose of intraventricular antimicrobial agents that
should be used in CSF shunt and drain infections; given the smaller CSF volume in infants (~50 ml)
compared to adults (~125–150 ml), doses in infants should probably be decreased at least 60% or
more compared to adults.
a
e usual intraventricular dose is 30 mg daily.
b
Not usually necessary but may be needed if removal of the device is too risky or the patient has not
responded to systemic antifungal therapy.
c
One study used 10 mg every day for 2 days and then 10 mg every 48 hours. Another study used 5 mg
or 10 mg every 72 hours. Data are based on isolated case reports.
d
Dose is 4–8 mg in adults; 1–2 mg in children.
e
Dosage recommendations in adults based on ventricle size/volume as follows:
Slit ventricles: 5 mg vancomycin and 2 mg gentamicin
Normal size: 10 mg vancomycin and 3 mg gentamicin
Enlarged ventricles: 15–20 mg vancomycin and 4–5 mg gentamicin.
f
Recommendations for frequency of administration based on external ventricular drain output over
24 hours as follows:
<50 mL/24 hours: every third day
50–100 mL/24 hours: every second day
100–150 mL/24 hours: once daily
150–200 mL/24 hours: increase the dosage by 5 mg of vancomycin and 1 mg of gentamicin and
give once daily.
200–250 mL/24 hours: increase the dosage by 10 mg of vancomycin and 2 mg of gentamicin and
give once daily.
g
Dose is 2 mg/day in children.
h
Most studies used a 10 mg or 20 mg dose.
