Intrathecal and/or Intraventricular Doses
Adapted from Clin Microbiol Rev 2010; 23:858-83 and Clin Infect Dis 2017;64:e34-65.
- Recommend Infectious Diseases consult.
- Antimicrobial agents administered by intrathecal or intraventricular route should be preservative free.
- When antimicrobial therapy is administered via an intraventricular drain, clamp the drain for 15–60 minutes to allow the agent to equilibrate throughout the CSF.
- Penicillins and cephalosporins should NOT be given by the intrathecal route as they have been associated with significant neurotoxicity, especially seizures.
| Drug | Doses | Reported severe adverse effects |
|---|---|---|
Amikacin |
Intrathecal/intraventricular: Adults: 20-30mg q24h |
Transient hearing loss, seizures, aseptic meningitis, and eosinophilic CSF pleocytosis. |
Amphotericin B |
Intrathecal: Neonates/children: 0.025-0.1mg q48-72h. May increase to 0.5mg as tolerated. Adults: 0.2-0.5mg q24-48h |
|
Colistin |
Intrathecal/intraventricular: Adults: 5-20mg colistin base/day, in 1 or 2 divided doses. NB: 5-20mg colistin base/day = 13.3-53.4mg colistimethate sodium (CMS)/kg/day. Each vial contains 150mg colistin base or 400mg CMS. |
Meningeal inflammation. High doses can cause seizures, anorexia, agitation, eosinophilia, edema, pain, and albuminuria. |
Daptomycin |
Intraventricular: Adults: 5-10mg q72h |
Fever |
Gentamicin |
Intrathecal/intraventricular: Newborns: 1mg q24h More than 3 months old: 1-2mg q24h Adults: 5-10mg q24h |
Transient hearing loss, seizures, aseptic meningitis, and eosinophilic CSF pleocytosis. |
Streptomycin |
Intraventricular: Adults: Up to 1mg/kg q24-48h |
Transient hearing loss, seizures, radiculitis, transverse myelitis, arachnoiditis, and paraplegia |
Tobramycin |
Intrathecal/intraventricular: Adults: 5-10mg q24h |
Transient hearing loss, seizures, aseptic meningitis, and eosinophilic CSF pleocytosis. |
Vancomycin |
Intrathecal/intraventricular: Pediatrics: 5-10mg q24h Adults: 10-20mg q24h |
Transient hearing loss. |