Antimicrobial prescribing: NHS Lothian
Blood culture X2 sets (10mls in each bottle)
CSF sampling for microscopy and culture
Post surgical ventriculitis/meningitis
Samples should be obtained prior to antibiotic initiation.
Removal of infected shunt/hardware is key.
Addition of intrathecal antibiotics should be strongly considered. The prescription and administration of intrathecal antibiotics can only be undertaken by appropriately trained staff on the local intrathecal register (see Neurology and Critical Care intranet pages).
For the management of ventriculitis in Critical Care, see guideline on the Critical Care intranet page
| Recommended antibiotic |
Vancomycin IV (use NHS Lothian Calculator on AMT intranet page); aim trough levels 15-20mg/L PLUS Ceftazidime 2g IV 8 hourly |
| Severe penicillin allergy |
Vancomycin IV (use NHS Lothian Calculator on AMT intranet page); aim trough levels 15-20mg/L PLUS Ciprofloxacin 400mg IV 8 hourly* |
*Avoid fluoroquinolones if taking steroids and the elderly. Review MHRA Quinolone Warning before prescribing. If an alternative agent is required please contact microbiology.
Discuss with microbiology and neurosurgery
10-14 days. Gram negative infection may be extended to 21 days.
Common organisms: Staph aureus, coagulase negative Staphylococci (especially S. epidermidis) and Gram-negative bacilli (including Pseudomonas spp).