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In Reply.—

Donald L. Trump, MD
Arch Intern Med. 1982;142(9):1756. doi:10.1001/archinte.1982.00340220184038.
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I appreciated the comments regarding our article entitled "CSF Infections Complicating the Management of Neoplastic Meningitis: Clinical Features and Results of Therapy." The specific questions have been answered as follows: (1) We did use the in vitro disk method, not the tube dilution method. (2) Staphylococcus epidermidis isolates in our institution are often sensitive to nafcillin. Hence, as we stated, our current regimen is nafcillin therapy. There is no question that this may be an inappropriate regimen for other institutions. A prophylactic regimen should be chosen based on experience at an individual institution. (3) I agree that a prospective trial will be required to determine which (if any) antibiotic prophylactic regimen is best. (4) With respect to CSF levels of antibiotics, I have a bias that CSF levels are less important than the antibiotic levels in the soft tissue surrounding the subcutaneous reservoir. Since none of the antibiotics under


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