Subarachnoid puncture via the anterior fontanelle with intrathecal vancomycin for refractory purulent meningitis: a pediatric case report

This case report presents a novel treatment approach for refractory purulent meningitis in a 1-month-old infant caused by penicillin-sensitive group B Streptococcus. Despite initial treatment with intravenous antibiotics, including penicillin and vancomycin, the infant experienced persistent symptoms and bilateral subdural effusions. Conventional therapies failed to resolve these issues, leading to the use of a new technique: subarachnoid puncture via the anterior fontanelle combined with intrathecal vancomycin administration. This minimally invasive procedure allowed for targeted antibiotic delivery, significantly reducing subdural effusions and improving cerebrospinal fluid parameters. The infant showed substantial clinical improvement and was discharged after 68 days with no complications during a 3-month follow-up. This approach offers a promising alternative to more invasive treatments such as craniotomy or subdural external drainage, though further research is needed to confirm its efficacy and safety in broader clinical contexts.