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Query: UMLS:C0085437 (bacterial meningitis)
 4,038 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Invasive disease due to Haemophilus influenzae type b (Hib) resistant to chloramphenicol and ampicillin is rare in the United States. Review of the literature reveals that all previously reported cases occurred in children with meningitis. These children were treated initially with ampicillin and chloramphenicol and had complicated courses characterized by delayed sterilization of the cerebrospinal fluid. The present report describes an infant who developed meningitis due to ampicillin- and chloramphenicol-resistant Hib. The patient received cefotaxime from the onset of therapy and had an uncomplicated course. The presence of Hib strains resistant to chloramphenicol and ampicillin should be considered in patients with meningitis due to Hib who respond poorly to treatment with these two drugs. Furthermore, the in vitro susceptibility of all Hib isolates to chloramphenicol (as well as to other antimicrobial agents) should be evaluated routinely. If the incidence of such resistant organisms increases, a change will be warranted in the commonly recommended combination of ampicillin and chloramphenicol as empiric therapy for bacterial meningitis in pediatric patients.
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PMID:Meningitis due to Haemophilus influenzae type b resistant to ampicillin and chloramphenicol. 264 66

A case of meningitis in a 16 month old boy caused by Hemophilus influenzae resistant to ampicillin is presented. The question is raised whether a third generation cephalosporin such as cefotaxime should be the drug of choice in the treatment of bacterial meningitis with unknown etiology.
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PMID:[The choice of antibiotics in purulent meningitis without bacteriologic diagnosis]. 265 40

Over the past 5 yr, we have conducted two clinical and two pharmacokinetic investigations of cefotaxime (CTX) and desacetylcefotaxime (dCTX) in neonates, infants, and children. A total of 50 children with culture-proven bacterial meningitis were randomized to receive either 200 mg/kg/day of CTX (n = 23, mean age 24.4 mo) or standard doses of ampicillin (AMP) and chloramphenicol succinate (CAPS; n = 27, mean age 16.6 mo). Results were similar between the CTX and Amp/CAPS groups for clinical/microbiological cures (100% versus 96%, respectively) and for survival without sequelae (78% vs. 77%, respectively). All bacterial isolates were sensitive to CTX, and the comparison of the MIC/MBC values for CTX to the CSF bactericidal titers suggested antimicrobial activity for dCTX. In a second clinical trial, 20 infants (1 wk-3 mo) were treated with 200 mg/kg/day of CTX for Gram-negative enteric bacillary meningitis. Cultures of CSF obtained 24 hr after the initiation of treatment were sterile in all subjects. Survival and complication rates of 95% and 21%, respectively, were observed. This compared favorably to previously published experiences with alternate treatment regimens for Gram-negative meningitis in the newborn. In both meningitis studies, the safety profile for CTX was excellent.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cefotaxime and desacetylcefotaxime in neonates and children: a review of microbiologic, pharmacokinetic, and clinical experience. 265 17

Sixteen hospitalized patients, aged between 10 and 76 years (mean: 34.3 years), with bacterial meningitis were treated i.v. with cefoperazone at daily doses of 4.5 g to 9 g. In two cases ampicillin was given in combination with cefoperazone during the last four days and the first five days of treatment, respectively. The following organisms were isolated: Neisseria meningitidis (n = 9), Haemophilus influenzae (n = 3), Escherichia coli (n = 2), Streptococcus pneumoniae (n = 2). Fourteen patients completely recovered from infection and the pathogens were eradicated; the treatment failed in only two patients and both were cured with alternative treatment. Furthermore, in 11 patients cefoperazone serum and CSF levels were determined four times during the first week of treatment (1st, 3rd, 5th and 7th days). No important side effects were recorded.
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PMID:Cefoperazone therapy of bacterial meningitis: a clinical trial. 269 58

Antimicrobial treatment of bacterial meningitis should be done by antibiotic to which the causative agent is susceptible, which attained serum levels ensure adequate penetration across the blood-brain barrier and which bactericidal levels in cerebrospinal fluid are achieved. A total number of 61 child in age from 2 months to 7 years with bacteriologically proved Haemophilus influenzae meningitis was included in the study. The possibility and usefulness of application of various antibiotics used in the treatment of this disease as well as the results attained have been discussed. A total number of 40 patients was treated with only one antibiotic (ampicillin 6, chloramphenicol 6, cefuroxime 3, cefotaxime 18, ceftazidime 7) and 21 patients were treated with combinations of antibiotics (ampicillin + chloramphenicol 14, cefuroxime + chloramphenicol 7). The causative agent was susceptible to the applied antibiotic in all cases. The agent susceptibility was estimated qualitatively by disk diffusion method and quantitatively by methods of minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC). Even 31.1% of H. influenzae strains were resistant to ampicillin. Penetration across the blood-brain barrier was monitored by estimation of antibiotic concentration in sera and liquor. Antibiotic concentrations in liquor attained the bactericidal levels. The same good results were attained with any of single applied antibiotics. In cases of delayed initiation of the antimicrobial therapy the appearance of neurological complications was more frequent, the outcome of the disease was worse and the duration of treatment was longer.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Antimicrobial treatment of Haemophilus influenzae meningitis in childhood]. 281 90

The parenteral kinetics of sulbactam, a potent synergist with ampicillin against a broad range of clinically important organisms in humans, are similar to those of ampicillin. The kinetics of ampicillin were not affected by co-administration of sulbactam, and high levels of both agents were attained: 15-min infusions of 2 g of ampicillin plus 1 g of sulbactam produced peak serum concentrations of approximately 120 micrograms of ampicillin/ml plus 60 micrograms of sulbactam/ml; intramuscular injections of 1 g of ampicillin plus 0.5 g of sulbactam produced peak concentrations of 18 micrograms of ampicillin/ml plus 13 micrograms of sulbactam/ml. The drugs had similar half-lives (approximately 1 hr), and both drugs were excreted primarily in the urine (greater than 75%). Although the kinetics of sulbactam in postpartem women and in surgical patients were similar to the kinetics in young men, the half-life of sulbactam (like that of ampicillin) was altered in the elderly, during labor, in neonates, and in patients with renal impairment. After distribution of the agents in the body, the concentrations of both drugs in blister and parenteral fluid were similar to those in serum. Furthermore, useful antibacterial concentrations of both drugs were found in pus, sputum, and middle-ear fluid. The normally low penetration of sulbactam and ampicillin into cerebrospinal fluid was increased in patients with bacterial meningitis.
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PMID:Pharmacokinetics of sulbactam/ampicillin in humans: a review. 302 97

Concentrations of sulbactam in the CSF of 18 patients with bacterial meningitis who were undergoing treatment with intravenous (iv) ampicillin were determined. Six patients received single doses of sulbactam (1 g) and 12 patients received multiple doses (four times daily) by the iv route at various intervals before lumbar punctures were performed to monitor their condition. Concentrations of sulbactam up to 12 micrograms/ml were detected in the CSF between 1 and 4 hr after dosing, the higher levels being present in the CSF of patients with the most severe meningeal inflammation. There were no significant differences in the concentrations achieved after single or multiple doses of sulbactam, and the concentrations were generally similar to the concurrent concentrations of ampicillin. It is concluded that these results as well as the antibacterial properties of sulbactam plus ampicillin support the evaluation of this combination as an alternative in the treatment of bacterial meningitis.
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PMID:Penetration of sulbactam into the cerebrospinal fluid of patients with bacterial meningitis receiving ampicillin therapy. 302 13

The emergence and spread of ampicillin-resistant Haemophilus influenzae type b strains have led to a sharp reduction in the use of ampicillin, or the addition of chloramphenicol, in the initial therapy of serious childhood infections. In some instances, third generation cephalosporins are used instead. The combination of ampicillin with sulbactam restores the former usefulness of ampicillin and extends its spectrum of activity to include normally ampicillin-resistant Staphylococcus aureus. Sulbactam/ampicillin should be useful in treating bacterial meningitis. It is more effective than third generation cephalosporins against Listeria and enterococci, and is more effective than ampicillin against Enterobacteriaceae. The combination also holds promise as a treatment for soft tissue, bone and joint infections in children.
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PMID:Sulbactam/ampicillin in paediatric infections. 306 53

70 children aged 4 months-12 years, with bacteriologically proven bacterial meningitis were treated with either intramuscular (IM) ceftriaxone (CFT) 100 mg/kg given once daily, or with combined IM ampicillin 160 mg/kg/day and IM chloramphenicol 100 mg/kg/day (AMC) given every 6 h. There were 35 children in each of the treatment groups. The children in both groups were comparable with regard to age, sex, duration of illness, and state of consciousness. 29 children in the CFT group and 26 in the AMC group recovered without any permanent complications or sequelae. Of the 15 children who died 10 (3 in the CFT and 7 in the AMC group) were in deep coma when treatment was started. Intramuscular CFT given once daily proved effective and much easier to administer than our standard hospital therapy with combined AMC given every 6 h IM.
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PMID:Intramuscular ceftriaxone versus ampicillin-chloramphenicol in childhood bacterial meningitis. 306 29

Twenty-six adults with acute bacterial meningitis were enrolled in an open randomized comparative study. The organisms isolated from CSF were Streptococcus pneumoniae, Staphylococcus epidermidis, Haemophilus influenzae, Escherichia coli and Salmonella typhi. 13 patients (group A) were treated once daily with intravenous ceftriaxone (Rocephin). The 13 patients in group B received ampicillin or ampicillin plus chloramphenicol in 4 doses/day. The mean duration of therapy in groups A and B was 9.9 and 12.3 days, respectively. This difference in the duration of therapy was statistically significant. All patients from group A showed clinical improvement and all were bacteriologically cured. In group B only 12 patients were clinically and bacteriologically cured; 1 patient had to be withdrawn from the therapy because CSF culture remained positive after 48 h of therapy. Ceftriaxone was well tolerated in all patients; ampicillin or ampicillin plus chloramphenicol were associated with diarrhea and skin rash in 6 patients.
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PMID:Ceftriaxone in the treatment of bacterial meningitis in adults. 307 45


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