[Intrathecal gentamicin in the treatment of meningitis--clinical case study (author's transl)].

The authors report 33 cases of meningitis treated with intrathecally administered gentamicin (GM) and examine it's effectiveness for meningitis side effects and optimum dose. Of 33 cases 15 cases (group I1 were treated with GM alone 7 cases (group IIa) with GM combined with SB--PC or CP. In 8 cases of the other 11 cases (group IIb) GM was changed for SB--PC or CP because of it's inefficiency and side effects (6 cases) and other reasons (2 cases). In the remaining three cases of group IIb SB--PC or CP was changed for GM due to their inefficiecy. Maximum intrathecal dose is shown below : 4 mg--7 cases, 8 mg--5 cases, 10 mg--15 cases, 20 mg--4cases, 40 mg--2 cases. In all cases GM was not administered systemically, but each of CP, CB--PC, SB--PC and TC was administereed systemically. In group I, only one case did not G--I tract bleeding but the others were cured. In group IIa all but one case was cured. In group IIb one case of cyptococcosis was dead. Total effective cases of intrathecal GM were 17 of 24 cases excluding group IIa (7 cases) and 3 cases of group IIb. There was no side effect in cases of which maximum dose was 4--20 mg, but in one of 40 mg administered cases in which GM was injected from cisternal puncture hearing, vestibular and visual function were disturbed permanently. Therefore GM should not be injected into the cistern. In our conclusion intrathecal GM is thought to be effective in the treatment of meningitis without systemic GM. Effective optimum dose in 4--8 mg/day day in adult and if ineffective after 7--10 days GM should be changed for other antibiotics.