Several reports have appeared in the literature of the use of penicillin intrathecally, with good results. Rammelkamp and Keefer1 treated 6 patients with intrathecal penicillin, including 2 with brain abscess and meningitis and 2 with meningitis. In 2 of the patients who died, penicillin was demonstrated in the cerebrospinal fluid removed from the third ventricle and from the cisterna magna. They suggested an initial dose of not more than 10,000 Florey units, followed by subsequent doses of 5,000 units every twenty to twenty-four hours. Absorption and excretion were more rapid in patients with meningitis than in those without meningitis. There were no reactions to the intrathecal penicillin except as evidenced by an increase in the number of leukocytes in the spinal fluid and an occasional headache.
A discussion arising from the death of a patient with streptococcic meningitis who had been treated with penicillin intrathecally produced the suggestion by
McCune WS, Evans JM. INTRAVENTRICULAR PENICILLIN IN THE TREATMENT OF STAPHYLOCOCCIC MENINGITIS. JAMA. 1944;125(10):705–706. doi:10.1001/jama.1944.72850280001007
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