Optimal antibiotic therapy for bacterial central nervous system infections in adults

The selection of antibiotics with proven CNS penetration and activity against the suspected or confirmed pathogens is essential, particularly in the context of emerging resistance. Higher daily doses and continuous or extended infusions (CI/EI) help maintain therapeutic concentrations in critically ill patients, while intrathecal (IT) administration of antibiotics should be considered when systemic therapy alone is insufficient. Therapeutic drug monitoring (TDM) is crucial for optimizing dosing, especially for drugs with narrow therapeutic indices. Although CSF TDM remains uncommon and challenging, it should be performed in specialized centers with experience in antibiotic pharmacokinetics.