A case of meningitis treated with intraventricular vancomycin in an infant

There is limited evidence for vancomycin (VCM) ventriculoperitoneal (VP) administration. We report a 3-month-old female with congenital hydrocephalus who developed a fever and was admitted to the hospital with a suspected VP shunt infection; she was being managed as an outpatient following VP shunt placement. Methicillin-resistant Staphylococcus aureus was detected on the removed catheter tip, and VCM treatment was initiated. Intravenous administration was ineffective, so intraventricular administration was initiated. Therapeutic drug monitoring (TDM) of cerebrospinal fluid (CSF) drug concentration showed a high trough level (30.9-50.0 μg/mL) at 2 mg daily dosing. Dose adjustment was implemented considering CSF drainage volume, and administration was changed to every other day. This case suggests that performing TDM and considering the amount of CSF drainage when establishing a detailed dosing regimen are important when administering VCM intraventricularly.