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

Until 1984 strains of Haemophilus influenzae type b (Hib) isolated from children with systemic infections in Australia had been uniformly sensitive to chloramphenicol. In July 1984 a child with bacteremia in Adelaide, South Australia, yielded a strain of Hib resistant to ampicillin, chloramphenicol and tetracycline. In October and November 1984 similar isolates were obtained on cerebrospinal fluid culture from 2 children with meningitis. The 3 isolates showed an identical resistance pattern and inactivated ampicillin and chloramphenicol. Each isolate was fully sensitive to moxalactam (latamoxef), and to cefotaxime. Both children with meningitis were treated initially with ampicillin and chloramphenicol given intravenously. One of these, a girl aged 16 mth, showed no improvement and a sixth cranial nerve palsy developed. When ampicillin and chloramphenicol were ceased and moxalactam was substituted there was a rapid clinical improvement. As initial therapy in children with bacterial meningitis we advocate using either moxalactam and ampicillin in combination or a suitable third generation cephalosporin such as cefotaxime.
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PMID:Multiply-resistant Haemophilus influenzae type b causing systemic disease in children in Australia. 349 69

Bacterial meningitis is a continuing challenge. This applies especially to infections in the neonate and the elderly, and to those which are hospital acquired. Factors which maintain the high morbidity and significant mortality from this disease include microbial virulence, a limited host response to infection within the cerebrospinal fluid (CSF), where phagocyte function is often impaired and complement and opsonic antibody activity are deficient, as well as delays in diagnosis and treatment. Added to these adverse factors is the pharmacokinetic hurdle of the 'blood-brain barrier', which limits drug concentrations achievable within the CSF. Inflammatory changes certainly improve the penetration of many agents, especially the penicillins and cephalosporins, but it must be remembered that with resolution of inflammation, achievable concentrations decline. Hence, the necessity for continuing parenteral administration of antibiotics throughout the treatment period. Although penicillin G (benzylpenicillin) remains the drug of choice for both pneumococcal and meningococcal infections, increasing resistance to ampicillin among Haemophilus influenzae has lead to greater reliance on alternative agents. Chloramphenicol is widely used, yet is potentially toxic, so that therapy with cefuroxime and the newer cephalosporins has been increasingly advocated. The advent of these potent, broad spectrum cephalosporins has induced a reappraisal of the treatment of Gram-negative bacillary meningitis, where ampicillin resistance and poor CSF penetration by the aminoglycosides have contributed to an unsatisfactory impact on outcome. Agents such as cefotaxime and ceftazidime have proved effective, although greater controlled experience is required. Finally, the contagious nature of meningococcal and H. influenzae infections justifies offering chemoprophylaxis to selected contacts, with rifampicin (or minocycline for contacts of patients with meningococcal infections).
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PMID:Bacterial meningitis. Rational selection and use of antibacterial drugs. 351 75

In a multicenter randomized trial, 107 children with bacterial meningitis were initially given either cefuroxime or ampicillin plus chloramphenicol. Patients were alternately assigned to 7- or 10-day courses of the designated antimicrobial regimen. CSF isolates included Haemophilus influenzae type b (89, of which 25% were beta-lactamase positive), Streptococcus pneumoniae, and Neisseria meningitidis. Although mean CSF bactericidal titers against Haemophilus isolates were 1:6 in each treatment group, H. influenzae was cultured from CSF in four of 39 patients receiving cefuroxime, 24 to 48 hours after initiation of therapy, compared with none of 40 patients given ampicillin plus chloramphenicol (P = 0.11). Clinical cure rates were similar (95%); one death occurred in each group. One child given cefuroxime had persistent meningitis after 5 days of therapy, and mastoiditis with secondary bacteremia developed in one on day 10. Three patients had relapse or reinfection. One patient who received cefuroxime for 10 days had a relapse of epiglottitis 17 days later, and of the patients given ampicillin plus chloramphenicol, one had a relapse of meningitis 1 week after 7 days of therapy, and bacteremia developed in one 42 days after completion of 10 days of therapy. No increase in either in-hospital complications or relapses occurred with a 7-day treatment course. Proof of the equivalence of the antibiotic regimens and the efficacy of 7-day courses of treatment, as well as the consequences of delayed CSF sterilization, will require additional investigation.
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PMID:Cefuroxime versus ampicillin plus chloramphenicol in childhood bacterial meningitis: a multicenter randomized controlled trial. 352 32

We studied 973 cases of childhood bacterial meningitis from 1979 through 1984 by means of questionnaire. Monotherapy was carried out in 47.9% of patients with case mortality of 10.3%, whereas those treated with 2 and 3 antibiotics revealed higher rates of 15.8% and 13.5%, respectively. Penicillins (PCs) were the most frequently used for monotherapy, and ampicillin (ABPC) accounted for 48.7%, then followed by cephalosporins (CEPs) group V including latamoxef (LMOX) for 26.8%, with fatality rates of 11.0% for the former and 9.6% for the latter. Chloramphenicol (CP) was used in 19 cases, 4 cases were treated with antibiotics other than PCs, CEPs, CP and aminoglycosides (AGs), and no death resulted. Among 418 cases treated with 2 different antibiotics, 241 cases with aminoglycosides (AGs) revealed a case mortality of 22.4%, and remaining 177 cases where AGs was not used showed a rate of 6.8% (P less than 0.05). One hundred and thirty-one cases treated with ABPC with gentamicin gave 29 deaths showing a significantly high mortality of 22.1%. Similar results were obtained for those treated with ABPC with other AGs. Combination of one PCs with another PCs and PCs with CEPs resulted in lower mortalities of 12.5% and 6.1%, respectively and the combination of beta-lactam with non-AGs antibiotics revealed only 4 deaths out of 74 cases, i.e., a case mortality of 5.4%. A gradual decrease of single or combined use of ABPC, mainly with AGs was observed during the survey period and a rapid increase of CEPs V and LMOX therapy occurred after 1982.
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PMID:[The trend of childhood bacterial meningitis in Japan (1979-1984). Part 3. On the antibiotic therapy and prognosis]. 359 81

In a total of 223 children over one month old suffering from purulent meningitis, there was a predominance (n = 96) of meningococci over hemophilus influenzae (n = 68) and pneumococci (n = 59). Crucial to therapeutic strategy for purulent meningitis is early diagnosis, in our laboratory covering both liquor and blood cultures. Initial therapy has to take account of these three chief causal agents. We have not as yet observed any resistance to penicillin from meningococci or pneumococci, and none of the liquor-cultivated hemophilus influenzae stock has been resistant to ampicillin. In the first two years of life, initial therapy for bacterial meningitis should include ampicillin, a liberal (300-400 mg/kg KM/d) dosage continuing to be important after the onset of improvement. In view of the lack of resistance of the causal agents cultivated, we had hitherto no cell to deploy modern cephalosporins in cases of bacterial meningitis in children.
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PMID:[Pathogen spectrum in bacterial meningitis in childhood and subsequent therapeutic strategy]. 368 7

Records of 366 children 0-15 years with bacterial meningitis (April 1982-March 1983) were reviewed in the framework of a medical audit. The general epidemiological pattern and the antibiotics administered are described and the patients in general hospitals are compared with those in academic hospitals. H. influenzae has been isolated from 31% of patients, N. meningitidis from 23% and S. pneumoniae from 10%. Case-fatality ratio was 6.6% overall, but it was higher in disease due to rare pathogens like E. coli and group B-Streptococcus (up to 25%). These rare pathogens were more common among patients in academic than in general hospitals. However, this difference was not significant, nor were differences in age distribution or case-fatality ratio between the two hospital categories. As initial therapy chloramphenicol plus a penicillin were administered to 30% of patients. On the fifth day of treatment ampicillin was the most frequently used antibiotic in general hospitals (31%), but in academic centres the above-mentioned combination (27%) and penicillin alone (24%) were most popular. It is argued that new antibiotics need to be evaluated carefully. Because this necessitates several hundreds of patients, multi-centered randomised trials should be carried out.
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PMID:Bacterial meningitis in 366 children in the Netherlands, 1982-1983. Epidemiology and antibiotic therapy. 370 51

Eighty-five infants and children were prospectively randomized to receive cefotaxime or ampicillin and chloramphenicol for therapy of bacterial meningitis. The two therapy groups of patients were comparable as to sex, age, clinical status on admission, prior administration of antibiotics and etiology. Three infants (7%) died in each therapy group. Mean number of days of positive cerebrospinal fluid cultures, time to defervescence and duration of treatment and of hospital stay and complications developing during treatment were similar for the two treatment regimens. Median cerebrospinal fluid bactericidal titers against the patients' pathogens in cefotaxime-treated patients (1:64) were larger than those in patients who received conventional therapy (1:8). Mild to moderate motor sequelae were more frequent in those given conventional therapy at the time of discharge only, and not at 4 months or longer of follow-up. We conclude that cefotaxime has similar efficacy when compared with conventional therapy for the management of bacterial meningitis in pediatric patients.
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PMID:Cefotaxime vs. conventional therapy for the treatment of bacterial meningitis of infants and children. 372 53

Bacterial meningitis in 20 children was treated with cefotaxime. 17 children received this antibiotic throughout the disease as monotherapy, three were changed to Penicillin G (2) or ampicillin (1), after sensitivity of the pathogen was known, although cefotaxime had been effective. All bacterial isolates were highly susceptible to cefotaxime. All CSF cultures were sterile at second tap, performed 24 to 48 hrs after therapy was started. Cefotaxime and desacetyl-cefotaxime concentrations in CSF, measured by HPLC in 9 patients were in the range of 4 to 34 (average 17.6) mg/l and 2.1 to 82 (average: 15.1) mg/l, representing a CSF-serum ratio of 8 to 74% (average 45.6%) for cefotaxime and 25 to 151% (average: 73.7%) for desacetyl-cefotaxime. Clinical outcome was favourable in 17 patients. There were one death and late neurological deficits in three. Cefotaxime monotherapy is recommended instead of standard therapy with chloramphenicol and/or ampicillin because of superior antibacterial activity, lower toxicity and lesser side-effects for primary meningitis in children caused by N. meningitides, S. pneumoniae, or H. influenzae type b.
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PMID:[Cefotaxime monotherapy in bacterial meningitis in childhood]. 379 34

Fifty children with bacterial meningitis were prospectively randomized to receive cefotaxime (50 mg/kg/dose every 6 hours) or ampicillin and chloramphenicol in standard doses. Twenty-three patients received cefotaxime and 27 received standard therapy. Bacterial isolates included: Haemophilus influenzae (29), Streptococcus pneumoniae (eight), Neisseria meningitidis (eight), group B streptococci (three), and Salmonella enteritidis (two). Ten (34%) of the H. influenzae isolates were resistant to ampicillin, nine on the basis of beta-lactamase production. All strains were susceptible to cefotaxime. Clinical cure rates for the cefotaxime (100%) and standard therapy (96%) groups were similar; survival without detectable sequelae was similar, at 78% and 77%, respectively. The duration of therapy, 11.1 +/- 2.4 days (range 10 to 21 days) vs 11.9 +/- 3.9 days (range 10 to 21 days), and days to defervescence, 4.7 +/- 2.6 days (range 1 to 14 days) vs 5.6 +/- 2.9 days (range 2 to 17 days), were similar in the cefotaxime and standard therapy groups, respectively. No adverse drug reactions or side effects were noted in either group. Cefotaxime was found to be as safe and effective as standard therapy for the treatment of bacterial meningitis in children.
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PMID:A prospective randomized comparison of cefotaxime vs ampicillin and chloramphenicol for bacterial meningitis in children. 384 86

Since 1974, ampicillin and chloramphenicol have been standard therapeutic agents for initial treatment of bacterial meningitis occurring after the newborn period. Emerging problems necessitate a reappraisal and a search for alternatives to those drugs. The problems include the following: (1) Some strains of pneumococci (between 3 and 16 percent) are relatively resistant, with minimal inhibitory concentrations between 0.1 and 1.0 microgram/ml) to penicillin G and ampicillin. Such strains are not eradicated from the cerebrospinal fluid by the usual dosages of penicillin G or ampicillin. (2) Some strains of Hemophilus influenzae type B are resistant to ampicillin and chloramphenicol by virtue of beta-lactamase and acetyltransferase production. Such strains are currently rare in the United States, but it has been predicted that they might account for as many as one quarter of the isolates within a few years. (In Barcelona, Spain, their prevalence is 18 percent.) (3) Patients with meningitis often receive phenobarbital or phenytoin. Those drugs, and others metabolized by the liver, can significantly affect the pharmacology of chloramphenicol and result in either subtherapeutic or toxic concentrations of chloramphenicol in some patients. (4) For a variety of reasons, neither ampicillin plus gentamicin nor ampicillin plus chloramphenicol is an ideal combination for infants between one and four months of age when etiologic agents include coliform bacilli and group B streptococci, as well as Hemophilus, pneumococci, and meningococci. First-generation cephalosporins were unsuitable for the treatment of meningitis because of their low concentrations in the cerebrospinal fluid in relation to the bactericidal concentrations required for the common pathogens. Several of the newer cephalosporins achieve therapeutic concentrations in the cerebrospinal fluid and, in the case of three cephalosporin derivatives (cefuroxime, cefotaxime, and moxalactam), large, controlled clinical trials have demonstrated activity comparable to that of standard therapy. Limited experience suggests that several other cephalosporins (e.g., ceftizoxime, ceftazidime) will be shown to be effective when more experience is gained. Furthermore, the use of these drugs, with the exception of moxalactam, which has insufficient activity against gram-positive cocci, obviates the four problems just cited.
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PMID:Emerging role of cephalosporins in bacterial meningitis. 384 60


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