Related Experiment Videos
Seven days vs. 10 days ceftriaxone therapy in bacterial meningitis
Pratibha Singhi1, Monika Kaushal, Sunit Singhi
1Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India. drsinghi@glide.net.in
Insights
Shorter, 7-day ceftriaxone therapy for acute bacterial meningitis (ABM) in children shows similar outcomes to 10-day treatment. This approach reduces hospital stays and nosocomial infections, offering a cost-effective alternative.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Acute bacterial meningitis (ABM) in children typically requires 10 days of ceftriaxone treatment.
- The high cost of ceftriaxone necessitates exploring shorter, equally effective treatment durations to reduce healthcare expenses.
Purpose of the Study:
- To compare the clinical outcomes of 7-day versus 10-day ceftriaxone therapy in pediatric patients with ABM.
- To assess treatment failure rates, complications, and long-term neurodevelopmental sequelae associated with different treatment durations.
Main Methods:
- A randomized study involving 73 children (3 months to 12 years) diagnosed with ABM.
- All patients received 7 days of ceftriaxone, with randomization on day 7 to continue for a total of 7 days (Group I) or 10 days (Group II).
- Clinical scoring, complication evaluation, and 1-month follow-up including neurodevelopmental assessments were performed.
Main Results:
- No significant difference in treatment failure rates or sequelae at discharge and 1 month between the 7-day and 10-day groups.
- Children receiving 7 days of ceftriaxone had a significantly shorter hospital stay (10.8 days vs. 14.4 days).
- The 10-day group experienced a higher frequency of nosocomial infections compared to the 7-day group.
Conclusions:
- Seven-day ceftriaxone therapy is as effective as 10-day therapy for uncomplicated ABM in children.
- A 7-day regimen is associated with reduced nosocomial infections and earlier hospital discharge.
- This shorter duration offers a potentially more cost-effective treatment strategy, especially in resource-limited settings.
Abstract:
Ceftriaxone is recommended in children with acute bacterial meningitis (ABM) for 10 days. However, the drug is expensive, and shorter duration of therapy, if equally effective, would cut costs of therapy and hospitalization. The aim of this study was to compare the outcome of 7 days vs. 10 days' ceftriaxone therapy in children with ABM. Seventy-three children aged 3 months to 12 years with ABM, consecutively admitted to hospital were enrolled. Ceftriaxone was given for 7 days to all. Randomization to group I (7 days) and group II (10 days) therapy was done on the seventh day. At the end of 7 days' therapy in group I and 10 days in group II, children were evaluated using a clinical scoring system. Children with a score of more than 10 were labelled as 'treatment failures' and were continued on ceftriaxone. If a score was less than 10, the antibiotic was stopped. Complications were appropriately evaluated and managed. All children were followed-up 1 month after discharge: neurodevelopmental assessment, Denver Development Screening Tests, IQ and hearing assessment were done. After excluding four patients, there were 35 children in group I and 34 in group II. The two groups were comparable with respect to age, sex, nutritional status, presenting clinical features, and CSF parameters. Organism identification was possible in 38 per cent of children: (Streptococcus pneumoniae, 21 per cent; Haemophilus influenzae, 13 per cent; meningococcus, 4 per cent). Treatment failure rate was comparable in both groups (9 in group I and 8 in group II) as was the sequelae at discharge and at 1 month (9 in group I, 15 in group II,p > 0.1). Status epilepticus and focal deficits at presentation were significantly associated with treatment failures and sequelae in both the groups (p < 0.05). Length of hospital stay was shorter in group I (10.8 +/- 6.0 days) as compared with group II (14.4 +/- 7.2 days,p < 0.05) and frequency of nosocomial infection was significantly more in group II (p < 0.05). It was concluded that clinical outcome of patients treated with 7 days' ceftriaxone therapy is similar to that of 10 days' therapy, and is associated with lesser nosocomial infection and earlier hospital discharge. Seven days ceftriaxone therapy may be recommended for uncomplicated ABM in children in developing countries.