Shunt or Extraventricular drain (EVD)
- Shunt removal should be considered ASAP.
Usual Pathogens
Coagulase negative Staphylococci
S. aureus
Enterobacterales
Pseudomonas spp (rare)
NB:
- If Gram positive seen on smear, use ceftriaxone + vancomycin.
- If Gram negative seen on smear, use meropenem.
- If nothing seen on smear and recent surgery, use meropenem + vancomycin.
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Ceftriaxone | 100mg/kg/d IV div q12h | Gram positive: ≥ 14 days Gram negative: ≥ 21 days |
| + | ||
| Vancomycin (pending cultures) | 60mg/kg/d IV div q6h |
Alternative if failure of above regimen, or colonized with ceftriaxone-resistant Gram negative, or Gram negative grows in blood or CSF cultures
| Empiric Therapy | Dose |
Duration |
|---|---|---|
| Meropenem | 120mg/kg/d IV div q8h | Gram positive: ≥ 14 days Gram negative: ≥ 21 days |
| + | ||
| 60mg/kg/d IV div q6h |