Treatment of Gram-Negative Meningitis and Ventriculitis

To the Editor: In a recent article, “Aminoglycoside Therapy of Gram-Negative Bacillary Meningitis” (N Engl J Med 293:1215, 1975) Kaiser and McGee point to the role of intrathecal and intraventricular therapy with gentamicin and tobramycin in gram-negative bacillary meningitis. Concerning the methods one important bit of information is missing: the dilution of drugs in the “vector fluid” (physiologic saline). Rieselbach et al. (Subarachnoid distribution of drugs after lumbar injection. N Engl J Med 267:1273–1278, 1962) have shown that the volume of an injected solution into the lumbar sac is an important factor in attaining widespread distribution. When compounds were. . .