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Intrathecal and Intraventricular Vancomycin: A Literature Review

Wombwell, Eric PharmD, BCPS*†; Young, Nathaniel PharmD*

Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0000000000000107
Review Articles

Abstract: Guidelines for administration of vancomycin into the cerebrospinal fluid are not available, and dosing strategies are based off of case reports and small clinical trials, with most data published before 2005. The objective of this article was to review available literature on direct administration of vancomycin into the cerebrospinal fluid for treatment of central nervous system–related infections and to determine current best therapeutic practice in dosing vancomycin by intrathecal or intraventricular administration. Upon literature review, cited initial vancomycin doses ranged from 5 to 50 mg/d. Maintenance dosing strategies tended to fall between 5 and 10 mg/d to maintain goal trough levels of 5 to 15 µg/mL. Therapeutic monitoring was a consistent recommendation made by authors to maintain therapeutic levels as well as to avoid possible toxicities associated with intraventricular and intrathecal vancomycin administration. Toxicities were limited in review but included mental status changes and headaches.

Author Information

From the *University of Missouri-Kansas City, School of Pharmacy, Kansas City; and †Centerpoint Medical Center, Independence, MO.

Correspondence to: Eric Wombwell, PharmD, BCPS, Division of Pharmacy Practice and Administration at the University of Missouri–Kansas City School of Pharmacy, 2464 Charlotte St, Kansas City, MO 64108. E-mail:

The authors have no funding or conflicts of interest to disclose.

© 2014 by Lippincott Williams & Wilkins.