Abstract Objective To systematically review the evidence for intrathecal or intraventricular plus intravenous administration of antibiotics compared with standard management for postsurgical meningitis or ventriculitis. Methods The following databases were searched: MEDLINE, the Central Register of Controlled Trials (CENTRAL); PubMed, EMBASE; and reference list of articles. Results Administration of intrathecal/intraventricular antibiotics was associated with decreased mortality (OR 0.27 [95% CI 0.15–0.49] p = < 0.00001), increased cure rate (OR 3.4 [95% CI 1.6–7.22] p = 0.001). There was no difference in the occurrence of reinfection rate, and in poor functional outcome (OR 0.57 [95% CI 0.21–1.60] p = 1.6 p = 0.29; OR 0.43 [95% CI 0.11–1.68] p = 0.22). Conclusions Intrathecal/intraventricular plus intravenous administration of antibiotics improves survival and cure rate in patients with postoperative meningitis or ventriculitis. More high-quality studies are needed.