Intraventricular Antibiotic Administration for the Treatment of Neonatal Ventriculitis: A Systematic Review

Neonatal ventriculitis is a complication of meningitis and is associated with high morbidity and mortality. Despite clinical importance, evidence regarding intraventricular antibiotic therapy has not been systematically collated. Our aim was to evaluate the existing literature on intraventricular antibiotic administration for neonatal ventriculitis, focusing on indications, antibiotic type, dosage, administration intervals, adverse effects, and patient outcomes. A systematic search of Ovid MEDLINE, PubMed, EMBASE, CENTRAL, and Scopus was conducted up to October 2025. Conference abstracts, letters, reviews, expert opinions, and studies including patients older than 28 days were excluded. Risk of bias was assessed using the Joanna Briggs Institute (JBI) appraisal tools for case reports and case series. The review was prospectively registered on PROSPERO (CRD420251018399). The inclusion criteria were met by 19 studies involving 43 neonates. Ventriculitis followed persistent or inadequately treated meningitis in 21 cases (48.8%). Most neonates (97.7%) received concurrent systemic antibiotics, mostly intravenously. Dosing regimens and administration intervals varied considerably, except for vancomycin, which was consistently administered at 10 mg daily. Overall survival was 79.1%. Clinical and laboratory improvement was reported in 30.2% of cases, while hydrocephalus occurred in 37.2%. Estimated in-hospital mortality was 9.3%, with hydrocephalus the leading cause of death. Intraventricular antibiotic therapy for neonatal ventriculitis has been described in small case series and case reports and may be associated with clinical and laboratory improvement. However, the low level of evidence precludes conclusions of effectiveness. Prospective studies are required to define its role alongside systemic therapy.