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

The third generation cephalosporins are very active against Haemophilus influenzae, including betalactamase producing strains, Neisseria meningitidis and against gram-negative bacilli. Considering that a CSF level at least 10 times the MIC for the causative agent must be achieved, some cephalosporins are limited in their use in meningitis. Randomized controlled studies are sparse and it is difficult to compare objectively the clinical efficacy of cephalosporins with that of commonly used regimens. Moxalactam, cefotaxime, ceftazidime and ceftriaxone were revealed as being at least as effective as standard antibiotics in the treatment of meningitis. Although the outcome from bacterial meningitis has not appreciably changed in a 14-year period from 1969 to 1982, when newer generation beta-lactam drugs were available, it is obvious that these drugs will be very useful in special situations, particularly where multiply resistant pathogens are involved. Finally, the role of third-generation cephalosporins in the treatment of bacterial meningitis is best approached by analysis based on age group and clinical setting.
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PMID:Role of third-generation cephalosporins in the treatment of bacterial meningitis. 379 77

Experience with the use of first-generation cephalosporins in bacterial meningitis has been disappointing; low concentrations were obtained in the cerebrospinal fluid, and therapeutic failures were encountered. Of the second-generation cephalosporins cefamandole, cefuroxime, and cefoxitin, only cefuroxime has proved efficacy in meningitis caused by meningococci, pneumococci, or Hemophilus influenzae. The third-generation cephalosporins offer new advantages in the treatment of meningitis because they are active at the cerebrospinal fluid concentrations obtainable. Cefotaxime has produced high cure rates in patients with meningitis caused by meningococci, pneumococci, or H. influenzae. Several controlled comparative studies indicate that ceftriaxone is as effective as conventional treatment in therapy for neonatal or childhood meningitis caused by Streptococcus agalactiae, Escherichia coli, or H. influenzae. Moxalactam has been found in uncontrolled studies to be effective when the cause was enteric gram-negative bacilli. Ceftazidime is a new cephalosporin with a high degree of beta-lactamase stability and a broad antibacterial spectrum, which includes Pseudomonas aeruginosa that enters the cerebrospinal fluid. Data from 29 patients who received ceftazidime as monotherapy for bacterial meningitis showed an overall cure or improvement rate of 75.9 percent. Therapy failed in three patients with meningitis caused by gram-positive organisms (Staphylococcus aureus, S. epidermidis, S. agalactiae), and in three with gram-negative organisms. Of 14 patients with Pseudomonas meningitis, 11 showed a cure, as did six of six patients with meningitis caused by Enterobacter, Serratia, or Acinetobacter. More, preferably controlled, studies of the efficacy of ceftazidime in the treatment of meningitis should be undertaken.
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PMID:Role of cephalosporins in the treatment of bacterial meningitis in adults. Overview with special emphasis on ceftazidime. 389 19

Penetration of moxalactam into the cerebrospinal fluid was studied in 11 patients with bacterial meningitis undergoing treatment with other antibiotics. Moxalactam at a dose of 20 mg/kg was administered as three 30- to 45- min infusions at 8-h intervals, once between days 2 and 4 and a second time between days 11 and 20 of treatment with the other antibiotics. Serum and cerebrospinal fluid were sampled 60, 90, or 120 min after the third moxalactam dose for measurement of the concentration of this drug by high-performance liquid chromatography. The concentration of moxalactam in cerebrospinal fluid ranged from 1.5 to 11 micrograms/ml, depending on the sampling time and the time elapsed since the onset of the disease. These concentrations in cerebrospinal fluid were equal to or higher than the minimum inhibitor concentrations for Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae (including ampicillin-resistant strains), and most of the gram-negative bacilli except for Pseudomonas aeruginosa. These results show that moxalactam has good penetrability when the meninges are inflamed and that it might be considered in cases of bacterial meningitis when the susceptibility of the pathogen indicates its usefulness.
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PMID:Moxalactam penetration into cerebrospinal fluid in patients with bacterial meningitis. 621 Nov 36

Increasing resistance to antibiotics in meningeal pathogens has stimulated a search for new antimicrobial agents for the treatment of bacterial meningitis. Moxalactam penetrates well into infected cerebrospinal fluid (CSF) and is highly active against most gram-negative bacteria. The clinical efficacy and safety of moxalactam in the treatment of childhood meningitis caused by Haemophilus influenzae (25 patients) or Neisseria meningitidis (five patients) was evaluated in a random, uncontrolled study. The penetration of the antibiotic into CSF was also evaluated in these patients and in another five children with bacterial meningitis. The clinical results were excellent, with 29 of 30 cases cured. The single adverse clinical reaction noted was the development of a wound hematoma in a postoperative patient; this problem may have been related to moxalactam therapy. The levels of moxalactam achieved in CSF greatly exceeded the minimal bactericidal concentrations for the infecting organisms. Moxalactam appears to be safe and effective as primary therapy for meningitis caused by H influenzae or N meningitidis.
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PMID:Moxalactam for the treatment of bacterial meningitis in children. 641 81

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 serum pharmacokinetics and CSF penetration of moxalactam were determined in 39 children with bacterial meningitis. The mean serum concentrations 30 minutes after a 37.5 or 50 mg/kg dose were 66.7 and 113 micrograms/ml, respectively. The t 1/2 beta was between 1.8 and 2.0 hours. The mean +/- 1 SD CSF/serum percentage was 18.5 +/- 16.0% (range 2.0 to 61%) for all children on any day of therapy or hour, after the last of three 50 mg/kg doses. Cerebrospinal fluid bactericidal titers were greater than or equal to 1:32 in 13 of 14 CSF specimens. Moxalactam adequately penetrates into the CSF of children with bacterial meningitis after repetitive 50 mg/kg doses.
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PMID:Pharmacokinetics and cerebrospinal fluid penetration of moxalactam in children with bacterial meningitis. 645 Feb 78

Moxalactam penetrates cerebral spinal fluid (CSF) and subdural fluid well enough to be a promising antimicrobial for enteric bacterial meningitis in neonates and infants. Clinical trials in adults and children have found few adverse effects. Prolongation of prothrombin time (PT) and partial thromboplastin time (PTT) with or without bleeding was reported in adults. This paper reports this complication in two infants occurring at a time of clinical improvement following addition of Moxalactam to other antibiotics to which the meningitis had failed to respond. It is not certain if this complication was related to the underlying meningitis, the use of Moxalactam together with other antibiotics, or a combination of many factors. Further observation, close hemostatic monitoring, and timely vitamin K administration during its use are warranted.
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PMID:Hemorrhagic tendency as a complication of Moxalactam therapy in bacterial meningitis. 663 97