Vancomycin and rifampin therapy for Staphylococcus epidermidis meningitis associated with CSF shunts

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Abstract
Three patients with S. epidermidis meningitis associated with CSF shunt devices were treated with a combination of i.v. vancomycin and oral rifampin. Two isolates were methicillin-resistant. All patients had a favorable clinical response. Time-kill curves showed that the addition of rifampin to vancomycin resulted in enhanced bactericidal activity against all isolates when compared to either antibiotic alone. The combination of oral rifampin and i.v. vancomycin may be useful in the treatment of methicillin-resistant and recalcitrant methicillin-sensitive S. epidermidis meningitis associated with CSF shunts. In vitro susceptibility testing should be performed.