Treatment of ventriculitis with gentamicin and cloxacillin in infants born with spina bifida.

Of 783 newborn infants with spina bifida cystica and cranium bifidum treated in the 6 years to December 1966, 11% died of ventriculitis. 24% of all deaths were due to this cause. Experience with treatment of ventriculitis with 2 of the antibiotic drugs, gentamicin and cloxacillin, during an 18-month period is presented. CSF levels were estimated during systemic and intraventricular administration of a drug and the clinical response was correlated with these levels. Of the 14 infants treated with gentamicin, the majority of whom had Gram-negative infections, 7 recovered. The 7 who died as a result of ventriculitis were mostly under 4 weeks of age. There was close correlation between the CSF levels attained and results of therapy. It was essential to give the drug intraventricularly to attain any recordable level, and to obtain the best results the systemic and intraventricular dose of the drug had to be adjusted to give CSF levels that exceeded the minimum inhibitory concentration considerably. 2 infants who recovered died later of other causes, but 4 of the 5 survivors had normal developmental attainments. No toxic effects were observed. The 7 infants treated with cloxacillin, all of whom had Gram-positive infections, survived, 3 with normal development. The importance of intraventricular administration of drugs and proper control of doses to achieve optimal therapeutic levels is emphasized.