Vancomycin hydrochloride, administered only intravenously, is a useful agent in the treatment of certain types of bacterial meningitis. Two cases are presented: a case of Flavobacterium meningosepticum meningitis, which promptly responded to vancomycin after unsuccessful therapy with five other antibiotics, and a case of Staphylococcus aureus meningitis, which did not respond to intensive therapy with methicillin sodium and chloramphenicol and was subsequently cured with vancomycin. The successful clinical results reported here suggest that adequate cerebrospinal fluid (CSF) levels are attained with intravenous therapy alone.
We recommend beginning therapy with intravenous administration of vancomycin in a dose of 40 mg/kg/day up to a maximum of 2 gm/day. Intrathecal therapy, 20 mg/day, should only be added if CSF is not sterilized after 48 hours of intravenous treatment.