INTRAVENTRICULAR GENTAMICIN THERAPY IN GRAM-NEGATIVE BACILLARY MENINGITIS OF INFANCY

Abstract

In a multicenter controlled trial in the USA and Latin America, 52 infants with meningitis and ventriculitis were randomly assigned to receive systemic ampicillin and gentamicin or intraventricular gentamicin plus systemic antimicrobial agents. The etiological agents most often encountered were Escherichia coli in the USA infants and Salmonella spp. in Latin American infants. Infants receiving systemic antibiotics plus intraventricular gentamicin had a significantly higher mortality rate (42.9%) than those who received systemic therapy only (12.5%). Duration of positive CSF cultures and morbidity rates were not significantly different in the 2 treatment groups. The concentrations of gentamicin in ventricular and lumbar CSF 1-6 h after an intraventricular dose of 2.5 mg gentamicin were 10-130 .mu.g/ml and 8-85 .mu.g/ml, respectively. The study was terminated early because of the higher mortality rate in the intraventricular-therapy group. Intraventricular gentamicin should not be used as routine treatment for neonatal meningitis caused by gram-negative enteric bacilli.