Intraventricular antibiotics for bacterial meningitis in neonates

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Intracerebroventricular and Intravascular Injection of Viral Particles and Fluorescent Microbeads into the Neonatal Brain

Published on: July 24, 2016

Sachin S Shah1, Arne Ohlsson, Vibhuti S Shah

  • 1Neonatal and Pediatric Intensive Care Services, Aditya BirlaMemorial Hospital, Pune, India. sshahdoc@gmail.com.

The Cochrane Database of Systematic Reviews
|July 13, 2012
PubMed
Abstract

Insights

Intraventricular antibiotics for neonatal meningitis increased mortality risk in one trial. This treatment should be avoided in infants with gram-negative meningitis and ventriculitis due to increased harm.

Area of Science:

  • Neonatal care
  • Infectious diseases
  • Pharmacology

Background:

  • Neonatal meningitis, particularly gram-negative bacterial infections, presents treatment challenges in cerebrospinal fluid (CSF).
  • Intraventricular antibiotic administration theoretically offers higher CSF concentrations than intravenous routes alone.
  • Ventricular taps, a method for intraventricular delivery, carry potential risks.

Purpose of the Study:

  • To evaluate the efficacy and safety of intraventricular antibiotics (with or without intravenous antibiotics) versus intravenous antibiotics alone in neonates with meningitis and ventriculitis.

Main Methods:

  • A systematic review of randomized controlled trials was conducted, searching multiple databases up to May 2011.
  • Included trials compared intraventricular antibiotics plus intravenous antibiotics against intravenous antibiotics alone in neonates (< 28 days old) with meningitis.
  • Outcomes assessed included mortality, neurodevelopment, hospitalization duration, CSF culture positivity, and side effects.

Main Results:

  • One study involving neonates and older infants with gram-negative meningitis and ventriculitis was included.
  • Intraventricular gentamicin combined with intravenous antibiotics significantly increased mortality (RR 3.43; 95% CI 1.09 to 10.74) compared to intravenous antibiotics alone.
  • No significant difference was observed in the duration of CSF culture positivity between the groups.

Conclusions:

  • The addition of intraventricular antibiotics to intravenous treatment in infants with gram-negative meningitis and ventriculitis led to a threefold increased risk of mortality.
  • Based on this single trial, intraventricular antibiotics, as administered in the study, should be avoided in this patient population.
  • Further research comparing these specific interventions is not warranted for this group.

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