Intrathecal gentamicin for refractory gram-positive meningitis

The mortality for meningitis due to Staphylococcus aureus or Listeria monocytogenes remains high, ranging from 32% to 77%. We treated a patient with staphylococcal meningitis refractory to methicillin sodium and oxacillin sodium, and a patient with Listeria meningitis refractory to penicillin G potassium and ampicillin sodium; both patients were cured when intrathecal gentamicin sulfate was added to the regimen. The combination of intrathecal gentamicin and a penicillin may be beneficial in refractory staphylococcal or Listeria meningitis.