Current recommendations for the empirical treatment of central nervous system (CNS) infection in the presence of a shunt recommend using IV vancomycin in combination with an agent that has adequate gram-negative coverage, such as cefepime, ceftazidime, cefotaxime, or meropenem. The ability of a medication to penetrate the CSF as well as the activity of the antibiotic against the bacterial biofilm are also important to consider for antibiotic choice ¹⁾.