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

Pharmacokinetic variables were studied in children with central nervous system infections who received a single dose of ceftriaxone sodium. After initial lumbar puncture of children with documented or suspected bacterial meningitis, ventriculitis, or both, therapy was initiated with i.v. ampicillin and chloramphenicol. Children were randomly selected to receive a single i.v. dose of ceftriaxone. Concentrations of ceftriaxone were measured in plasma at intervals from 0 to 720 minutes after the beginning of the infusion and in cerebrospinal fluid (CSF) at one to five hours after the dose. Blood samples were obtained immediately after the second lumbar puncture for assessment of drug penetration into CSF. Elimination rate constant, elimination half-life, apparent volume of distribution, and plasma clearance were determined from samples obtained 30-720 minutes after the start of the infusion. In two children with ventriculoperitoneal shunts, serial determinations of ceftriaxone in CSF were obtained. All eight children who received 75 mg/kg and five of eight who received 50 mg/kg had positive CSF cultures. Volume of distribution was less after the 50 mg/kg dose than after the 75 mg/kg dose. In the children with shunts, adequate CSF drug concentrations were maintained throughout 12 hours of testing. These data support a 12-hour dosage interval, but clinical studies are needed to evaluate efficacy of the drug at both 12-hour and 24-hour dosage regimens.
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PMID:Single-dose plasma and cerebrospinal fluid pharmacokinetics of ceftriaxone in infants and children. 631 77

Forty-five children (aged 1 day to 15 years) with bacterial meningitis were randomized to receive either traditional therapy (ampicillin and chloramphenicol or gentamicin, pending sensitivity) or ceftriaxone (100 mg/kg per day in two doses for a minimum of 10 days). The etiological agents involved were similar for the two groups and included Haemophilus influenzae type b, Neisseria meningitidis, Streptococcus pneumoniae, and group B streptococcus. Repeat spinal taps were carried out 24 to 48 h after admission. Organisms were seen on the Gram stain of one patient treated with ceftriaxone, but five patients in the traditional therapy group had organisms present on Gram stain of uncentrifuged spinal fluid or positive cultures of the spinal fluid (or both). Ceftriaxone entered the cerebrospinal fluid well, and the average cerebrospinal fluid bactericidal activity for ceftriaxone 1 h after a dose was at least 60 times greater than for ampicillin or chloramphenicol. In those patients who received treatment for a long enough period of time to permit evaluation, there was one death in each group, both due to S. pneumoniae. The length of fever and complications were similar for the patients in both groups. Ceftriaxone was well tolerated; diarrhea, seen in 5 of the 22 patients who received the drug, was the most commonly encountered adverse effect. It was mild, and in no case was it necessary to discontinue the drug. Ceftriaxone appears in this preliminary study to be a safe and acceptable single agent for the treatment of bacterial meningitis in children.
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PMID:Comparison of ceftriaxone and traditional therapy of bacterial meningitis. 632 81

Outcome from bacterial meningitis in infants and children has not appreciably changed in a 14-year period from 1969 to 1982 at Children's Medical Center and Parkland Memorial Hospital, Dallas, Texas. Overall, the case-fatality rate was 6.4 percent; it was 4.6 percent for 414 patients managed in 1969 to 1972 and 3.9% for 376 patients in 1981 and 1982. In neonatal meningitis due to group B streptococci or coliform bacilli, the fatality rates were comparable in 1969 to 1972 and 1981 and 1982; ampicillin and an aminoglycoside were the mainstays of therapy during these periods. Because of changing susceptibilities of gram-negative enteric bacilli to the aminoglycosidic agents, Haemophilus influenzae to ampicillin and possibly chloramphenicol and of Streptococcus pneumoniae to penicillin, alternatives to conventional therapy must be developed and thoroughly tested. Assessment of new antimicrobial agents in the rabbit model of experimental meningitis provides valuable information on penetration of drug into cerebrospinal fluid, on achievable bactericidal activity in spinal fluid and on the bacteriologic effect of single dose or nine hour infusion therapy. These data are directly applicable to therapy in infants and children with meningitis. Although newer antimicrobial agents such as moxalactam, cefotaxime, or ceftriaxone have greatly enhanced bactericidal activity against the commonly encountered pathogens, outcome from meningitis will not be substantially improved with therapy using these agents. Improved outcome will more likely occur with the advent of therapeutic modalities that prevent or rapidly decrease cerebral edema and cerebritis, thereby preserving cerebral perfusion pressure and cellular integrity.
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PMID:Management of bacterial meningitis in infants and children. Current status and future prospects. 637 73

In recent years there has been a renewal of interest in chloramphenicol, predominantly because of the emergence of ampicillin-resistant Haemophilus influenzae, the leading cause of bacterial meningitis in infants and children. Three preparations of chloramphenicol are most commonly used in clinical practice: a crystalline powder for oral administration, a palmitate ester for oral administration as a suspension, and a succinate ester for parenteral administration. Both esters are inactive, requiring hydrolysis to chloramphenicol for anti-bacterial activity. The palmitate ester is hydrolysed in the small intestine to active chloramphenicol prior to absorption. Chloramphenicol succinate acts as a prodrug, being converted to active chloramphenicol while it is circulating in the body. Various assays have been developed to determine the concentration of chloramphenicol in biological fluids. Of these, high-performance liquid chromatographic and radioenzymatic assays are accurate, precise, specific, and have excellent sensitivities for chloramphenicol. They are rapid and have made therapeutic drug monitoring practical for chloramphenicol. The bioavailability of oral crystalline chloramphenicol and chloramphenicol palmitate is approximately 80%. The time for peak plasma concentrations is dependent on particle size and correlates with in vitro dissolution and deaggregation rates. The bioavailability of chloramphenicol after intravenous administration of the succinate ester averages approximately 70%, but the range is quite variable. Incomplete bioavailability is the result of renal excretion of unchanged chloramphenicol succinate prior to it being hydrolysed to active chloramphenicol. Plasma protein binding of chloramphenicol is approximately 60% in healthy adults. The drug is extensively distributed to many tissues and body fluids, including cerebrospinal fluid and breast milk, and it crosses the placenta. Reported mean values for the apparent volume of distribution range from 0.6 to 1.0 L/kg. Most of a chloramphenicol dose is metabolised by the liver to inactive products, the chief metabolite being a glucuronide conjugate; only 5 to 15% of chloramphenicol is excreted unchanged in the urine. The elimination half-life is approximately 4 hours. Inaccurate determinations of the pharmacokinetic parameters may result by incorrectly assuming rapid and complete hydrolysis of chloramphenicol succinate. The pharmacokinetics of chloramphenicol succinate have been described by a 2-compartment model. The reported values for the apparent volume of distribution range from 0.2 to 3.1 L/kg.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Clinical pharmacokinetics of chloramphenicol and chloramphenicol succinate. 637 31

The current incidence of neonatal sepsis in the United States varies from less than 1 to 8.1 per 1000 live births. The incidence of bacterial meningitis is about one-third of the number of infants with sepsis. The mortality is 20 to 30% and many survivors are severely impaired. Group B streptococcus and Escherichia coli are the most frequent causes of meningitis. Because of the difficulty of clinical diagnosis, many infants receive presumptive therapy for suspected sepsis or meningitis although few have documented infection. Between 5 and 10% of newborn infants born in the United States receive antimicrobial agents in the nursery, usually a penicillin and an aminoglycoside. To lower the continued high mortality and morbidity of meningitis due to gram-negative enteric bacilli, collaborative randomized trials evaluated the efficacy of gentamicin administered via the intrathecal route, gentamicin administered into the ventricle and most recently, the efficacy of moxalactam. Neither intrathecal or intraventricular drug, both in combination with parenteral drug, was advantageous when compared with parenterally administered drug alone. The mortality rate and number of days of culture positive cerebrospinal fluid were similar in infants who received moxalactam and ampicillin and infants who received amikacin and ampicillin. Adjunctive therapies including granulocyte transfusion, administration of hyperimmune gamma globulin and exchange transfusion are now under investigation. Initial studies of prevention of systemic bacterial infection by prophylactic ampicillin administered to the mother at delivery and use of group B streptococcal vaccine administered to susceptible women in the child bearing age show promise.
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PMID:Recent advances in management of bacterial meningitis in neonates. 639 49

Bacterial meningitis of infants and children exact a major toll worldwide. Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis continue to be the major causes, and efforts to reduce the incidence of this disease have had limited success. Major advances in rapid diagnosis, such as antigen detection, have occurred over the past several decades; however, Gram stain, cytologic examination and culture of the CSF remain the most reliable means of making an etiologic diagnosis. Despite shifts in bacterial susceptibilities to commonly used antibacterial agents, penicillin, ampicillin and chloramphenicol remain effective therapy for the vast majority of cases, although newer cephalosporin derivatives may be required to avoid the toxicities of chloramphenicol and to effectively treat selected bacteria that have developed resistance to these more classical antibiotics. The prognosis for bacterial meningitis in infants and children remains guarded because of late diagnosis and the severity of the disease. Major reductions in the incidence of the disease will depend on definition of high-risk populations and application of appropriate preventions.
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PMID:Bacterial meningitis in infants and children. 639 50

Excellent clinical results were observed with the combination therapy of chloramphenicol with beta-lactam-antibiotics in the treatment of purulent meningitis. This came as a surprise as bacteriostatic antibiotics like chloramphenicol are commonly thought to antagonize the bactericidal action of penicillin or ampicillin. We reevaluated the mode of action of chloramphenicol against the three most common meningeal pathogens after the newborn period. Chloramphenicol was found to be bactericidal against H. influenzae, Streptococcus pneumoniae and Neisseria meningitidis at clinically achievable levels in the CSF. In addition chloramphenicol showed synergistic action with ampicillin against H. influenzae which can possess clinical relevance particularly with the high inoculum of 10(7) organisms/ml which is frequently seen in bacterial meningitis. No synergism was found against Pneumococci and Meningococci but also no antagonism of the lower MIC and MBC values seen with ampicillin and penicillin G. The combination of chloramphenicol with either penicillin or ampicillin constitutes a clinically successful therapeutic regimen which is now also proven by in vitro investigations.
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PMID:[Bactericidal action of chloramphenicol and synergism with beta-lactam antibiotics]. 640 8

Neonatal bacterial meningitis continues to cause substantial mortality and morbidity despite the advent of new antimicrobial agents and of modern intensive care facilities. In Dallas, the case-fatality rate for bacterial meningitis in newborn and young infants is 17% (40 of 231 patients). Three pathogens, Group B streptococcus, Escherichia coli and Listeria monocytogenes, accounted for 84% of the causative agents. Although new beta-lactam antibiotics have been extensively evaluated in experimental meningitis due to these pathogens, there is limited clinical experience from which to judge efficacy and safety. Currently, conventional therapy with ampicillin and an amino-glycoside should be used as initial empirical therapy for neonatal meningitis. Once the pathogen has been identified and the susceptibilities determined, the most appropriate antibiotic or combination of antibiotics can be selected. Latamoxef (moxalactam) and cefotaxime are highly active agents in vitro against Gram-negative enteric bacilli and may prove useful for therapy of meningitis due to those organisms. Additional experience with these compounds is required before they can be recommended for routine use.
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PMID:Management of neonatal meningitis, 1984. 643 45

The concentrations of mezlocillin in the cerebrospinal fluid were measured in ten patients with viral meningitis after a single infusion of 5 g lasting 30 minutes. One to two hours after infusion the CSF concentrations were between 0.1 mcg/ml and 1.6 mcg/ml, and thus exceeded the minimal inhibitory concentrations of Neisseria meningitidis and Diplococcus pneumoniae, the most common pathogens in bacterial meningitis in adults. The minimal inhibitory concentration of ampicillin-sensitive strains of Haemophilus influenzae was also attained. Further investigations must be carried out, in order to ascertain whether higher CSF concentrations are attained in bacterial meningitis.
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PMID:[Concentrations of mezlocillin in cerebrospinal fluid in vira meningitis (author's transl)]. 645 3

Meningitis is the major pathologic manifestation of Listeria monocytogenes in the United States. Despite the fact that this organism has a well-known predilection for individuals who are pregnant or immunocompromised, to date, maternal listeric meningitis remains an unreported entity in the English literature. The authors report two cases of this disease and review the diagnosis and treatment of meningitis in general and, more specifically, of listeric meningitis in pregnancy. It is recommended that the initial treatment of bacterial meningitis during pregnancy should be a combination of ampicillin and gentamicin pending definitive identification of the causative organism and its antibiotic sensitivity pattern.
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PMID:Listeria meningitis during pregnancy. 651 70


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