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Intraventricular and parenteral gentamicin therapy for ventriculitis in children
Insights
Intraventricular gentamicin sulfate effectively treated ventriculitis in children with shunts when intravenous administration failed. This targeted approach achieved therapeutic cerebrospinal fluid (CSF) levels, proving safe and effective for resistant bacterial infections.
Area of Science:
- Pediatric Infectious Diseases
- Neurosurgery
- Pharmacology
Background:
- Ventriculitis in children with intraventricular shunts presents a therapeutic challenge.
- Cerebrospinal fluid (CSF) infections often involve multi-drug resistant organisms.
- Intravenous antibiotics may not achieve adequate gentamicin concentrations in the CSF.
Purpose of the Study:
- To evaluate the efficacy and safety of intraventricular gentamicin sulfate for treating ventriculitis in pediatric patients with shunts.
- To determine achievable gentamicin concentrations in ventricular CSF following intraventricular administration.
- To assess the long-term outcomes of this therapeutic approach.
Main Methods:
- Retrospective analysis of five pediatric patients with ventriculitis and intraventricular shunts.
- Administration of intraventricular gentamicin sulfate (1 mg) alongside complete shunt removal.
- Monitoring of gentamicin concentrations in ventricular CSF.
- Clinical and microbiological follow-up for 12 to 24 months.
Main Results:
- No gentamicin was detected in ventricular CSF with intravenous administration alone.
- Intraventricular gentamicin achieved concentrations >20 microgram/ml at 1 hour and 5-14 microgram/ml at 36 hours post-administration.
- Patients received intraventricular gentamicin for an average of 16 days without complications or relapse.
- All patients achieved clinical cure and microbiological eradication.
Conclusions:
- Intraventricular gentamicin sulfate is an effective and safe treatment for ventriculitis caused by gentamicin-sensitive, multi-drug resistant bacteria in pediatric patients with shunts.
- This targeted delivery method overcomes the limitations of intravenous administration in achieving therapeutic CSF drug levels.
- Combined with shunt removal, intraventricular gentamicin offers a viable therapeutic strategy for refractory ventriculitis.
Abstract:
Five children with intraventricular shunts developed ventriculitis due to organisms resistant to multiple antimicrobial agents but sensitive to gentamicin sulfate. No gentamicin was detected in ventricular CSF of four patients at a time when gentamicin was being administered only intravenously. The intraventricular administration of 1 mg of gentamicin resulted in ventricular CSF concentrations greater than 20 microgram/ml one hour and 5 to 14 microgram/ml 36 hours after administration. Patients were treated with intraventricularly given gentamicin for an average of 16 days, with no apparent complications or relapses during the 12- to 24-month follow-up period. Intraventricularly administered gentamicin sulfate (1 mg every 24 to 36 hours) in conjunction with complete shunt removal was an effective means of therapy of ventriculitis caused by bacteria resistant to antibiotics that readily penetrate the blood-brain barrier.