Teicoplanin in the therapy of staphylococcal neuroshunt infections

Three patients with staphylococcal infection of neuroshunt, two with ventriculoperitoneal and one with external ventricular derivation, were treated with teicoplanin given intravenously (iv) or intraventricularly (ivt), two patients were adults, while the third was an infant. The causative organisms were methicillin-sensitive Staphylococcus epidermidis (MSSE) in the first two cases and methicillin-sensitive Staphylococcus aureus (MSSA) in the paediatric patient. Patient No. 1 was given teicoplanin iv (400 mg/day) and subsequently ivt (20 mg/day). CSF teicoplanin levels were always below 1 microgram/ml during the first part of the treatment; after the institution of ivt therapy, drug levels ranged from 20 to 35 micrograms/ml (mean 26.4). The patient was cured after 20 days of a combination treatment (ivt teicoplanin plus rifampin, 900 mg/day, iv). Patient No. 2 was given teicoplanin 400 mg/day, iv, for two weeks; its low levels in CSF (always below 0.5 microgram/ml) accounted for the failure to eradicate the MSSE. A new regimen with teicoplanin, 20 mg/day plus netilmycin, 15 mg/day, both ivt, cured the patient in two weeks. Teicoplanin levels in the CSF ranged from 12.5 to 33 micrograms/ml (mean 18.3). Patient No. 3, an 8-month-old infant, was placed on teicoplanin, 5 mg/day ivt plus chloramphenicol, 180 mg/day iv, after several other antibiotic trials had failed to eradicated a MSSA infection of his external ventricular derivation. The therapy cleared the infection in one week (CSF teicoplanin levels: 30 to 38, mean 34 micrograms/ml). Teicoplanin (iv or ivt) was well tolerated without any significant side-effects; its role in the treatment of staphylococcal neuroshunt infections deserves further studies.