Intraventricular tobramycin in a premature infant with pseudomonas meningitis

A 38-week postconceptional age (29-week gestational age) infant required the placement of an Ommaya reservoir following a grade IV intraventricular hemorrhage and progressive hydrocephalus. At 70 days of age, a cerebrospinal fluid (CSF) culture was positive for Pseudomonas aeruginosa and the infant was empirically treated with age-appropriate parenteral doses of ceftazidime and gentamicin. This antibiotic regimen was changed to meropenem and tobramycin following the results of sensitivity reports. The infection failed to respond despite aggressive systemic dosing of antibiotics and removal of the Ommaya reservoir. Intraventricular injections of tobramycin were added to the systemic antibiotic regimen at a dose of 2 mg daily with subsequent doses adjusted to maintain trough concentrations in the CSF of 20-30 μg/mL. The CSF was sterilized after three days of intraventricular injections. The infant completed seven days of intraventricular tobramycin plus a 24-day regimen of systemic antibiotics. No acute complications were noted with the addition of intraventricular injections.