Clinical Consultation: Continuous Antibiotic Irrigation Through the IRRAflow Device for Central Nervous System Infections.

Bacterial central nervous system (CNS) infections carry high morbidity and mortality, and their management is complicated by limited antibiotic penetration across the blood brain barrier. The IRRAflow system is a dual-lumen ventricular catheter that enables continuous active cerebrospinal fluid exchange and has been used off-label for antibiotic delivery in refractory CNS infections. This clinical consultation reviews the available evidence, describes the device and its proposed rationale, and offers practical guidance for clinicians. Published experience is limited to case reports, case series, and small retrospective cohorts. In addition, there is no pharmacokinetic data available and clinical dosing is described for only two agents. The available evidence is insufficient to establish efficacy, define safe-use criteria, or support dosing strategies. Continuous antibiotic irrigation via IRRAflow cannot currently be recommended for routine use. Where it is used, it should be reserved for infections refractory to standard care, at experienced centers, with active clinical pharmacist involvement in agent selection, dosing, and monitoring, ideally within a prospective study.