Pharmacokinetics of intraventricularly administered teicoplanin in Staphylococci ventriculitis

Following craniotomy for a medulloblastoma in the posterior cranial fossa, a 6-year old girl developed a ventriculitis with coagulase negative staphylococci associated with the use of a ventriculostomy. Treatment with intravenous (i.v.) and intraventricular (ivt) vancomycin resulted in negative cultures of the cerebrospinal fluid, but had to be stopped because of a severe allergic skin reaction. Teicoplanin was administered i.v. (240 mg once daily) and ivt (10 mg once daily), resulting in high teicoplanin CSF levels that were used to model the pharmacokinetics of ivt teicoplanin in this patient. No signs of recurrent infection or adverse events occurred. It is concluded that a pharmacokinetic model can be derived from this case that can be used as prior to guide teicoplanin intraventricular therapy in other patients.