Intraventricular Administration of Cefepime for the Treatment of Meningitis due to Pseudomonas aeruginosa

Beta-lactam antibiotics are traditionally not considered for intrathecal therapy, despite their poor penetration into the cerebrospinal fluid (CSF) during intravenous therapy, because target concentrations of the beta-lactam antibiotic in the central nervous system can usually be achieved with a higher intravenous dose [1]. However, in cases where inadequate clinical response is seen even with maximal doses of intravenous antibiotics, and when access for intraventricular administration of antibiotics is available, this route can be utilized for patient management, as we report now. Cefepime at high doses has been reported to cause seizures and encephalopathy [2]. However, therapeutic intraventricular administration of cefepime for the management of nosocomial meningitis, leading to successful microbiological clearance has not been reported previously in the literature.