[Infections of the cerebrospinal fluid shunt]

The treatment of infectious complications of implanted foreign bodies into the CNS is unsatisfactory. In the majority of these patients staphylococci are responsible for these infections which elicit only a smoldering inflammatory response with poor penetration of antibiotics into the CSF. It is also very difficult to eradicate staphylococci from the surface of silastic material by antibiotics. Fosfomycin was investigated in the treatment of CSF infections in patients with infected ventriculoatrial shunts. Fosfomycin exhibits a potent antimicrobial activity against staphylococci; this drug also showed a favourable penetration into the CSF in moderately inflamed meninges. A 10 days therapeutic course with fosfomycin plus oxacillin or cefamandole and gentamycin in combination with external drainage of the CSF into a closed system made it possible to exchange all parts of the system in one session without reinfection. This procedure was followed by the same antibiotic regimen postoperatively for 10-14 days. Under this treatment schedule therapeutic results have been considerably better compared to previous treatment modalities.