Infectious Diseases consult recommended for assistance with timing of shunt replacement and duration of therapy.
Removal of all components of the infected shunt with external ventricular drainage or intermittent ventricular taps in combination with the appropriate intravenous antibiotic therapy leads to the highest effective cure rates. Success rates are substantially lower when the infected shunt components are not removed.
Intraventricular antibiotics are occasionally used, particularly when there has been no improvement after 48 hours, for refractory cases, or cases in which shunt removal is not possible. Intraventricular injection should be administered only by experienced practitioners, such as the Neurocritical care service.