Recommended Dose of Intrathecal Colistin for Postoperative Meningitis
The recommended dose of intrathecal colistin for postoperative meningitis is 125,000-250,000 IU (approximately 10 mg) administered once daily. 1
Dosing Guidelines for Intrathecal/Intraventricular Colistin
- The Infectious Diseases Society of America recommends a daily intrathecal/intraventricular dose of 10 mg for colistin in bacterial meningitis (A-III evidence level) 1
- For adults with postoperative meningitis caused by multidrug-resistant organisms, the recommended intrathecal colistin dose ranges from 125,000 IU to 250,000 IU once daily 1
- In clinical practice, the median daily intrathecal/intraventricular dosage used in adults has been reported as 125,000 IU, with a range between 20,000 IU and 500,000 IU administered once or twice daily 1
- Some experts advocate for a loading dose of 500,000 IU when initiating intrathecal colistin therapy, though this remains controversial 1
Administration Considerations
- Intrathecal colistin should always be used in combination with appropriate intravenous antimicrobial therapy for optimal outcomes 1
- For postoperative meningitis caused by multidrug-resistant Acinetobacter baumannii, the combination of intravenous plus intrathecal/intraventricular colistin is necessary to achieve therapeutic concentrations in the central nervous system 1
- Successful clinical and bacteriological outcomes of 89% have been reported in patients treated with intrathecal or intraventricular colistin for Acinetobacter CNS infections 1
Duration of Therapy
- The recommended duration of antimicrobial therapy for gram-negative meningitis is 21 days 1
- Treatment should be guided by monitoring cerebrospinal fluid sterilization through repeated cultures 1
- For aerobic gram-negative bacilli meningitis, a full 21-day course of antimicrobial therapy is recommended 1
Clinical Evidence and Safety
- Case reports have demonstrated successful treatment of multidrug-resistant Acinetobacter baumannii meningitis with intrathecal colistin doses ranging from 3.2 mg to 10 mg daily 2, 3
- The median time to achieve cerebrospinal fluid sterilization with intrathecal/intraventricular colistin is approximately 4.1 days 2
- Toxicity potentially related to topical administration of colistin has been reported in approximately 15% of treated patients 2
- Successful outcomes have been reported with intrathecal colistin in both adult and pediatric patients with gram-negative meningitis unresponsive to standard intravenous therapy 4, 5, 6
Important Considerations and Precautions
- Renal function should be closely monitored during colistin therapy due to the risk of nephrotoxicity 1
- Removal of infected CSF shunts and implementation of external drainage, in combination with appropriate antimicrobial therapy, is recommended for CSF shunt infections 1
- For empirical treatment of post-neurosurgical meningitis in areas with high rates of carbapenem resistance, high-dose meropenem (2g TID) plus colistin is recommended, with the addition of intrathecal/intraventricular colistin for multidrug-resistant isolates 1