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Cerebrospinal fluid penetration of cefmenoxime in children with bacterial meningitis
A Eicken1, J G Schöber, R Roos
1Kinderkrankenhaus, München, Germany.
Abstract:
Blood and cerebrospinal fluid (CSF) concentrations of cefmenoxime were determined either microbiologically or by means of HPLC in 20 children with proven or suspected bacterial meningitis. Sixteen children suffered from bacterial meningitis: causative organisms were Haemophilus influenzae type b (n = 10), Streptococcus pneumoniae (n = 4) and Neisseria meningitidis (n = 2). In these patients the cefmenoxime concentration in the CSF ranged from 0.9 to 12.2 mg/l, with a mean concentration of 4.63 mg/l 1.5-3 h after the last intravenous cefmenoxime application and 24-48 h after initiating therapy with 200 mg cefmenoxime/kg/d in four doses. In eight cases the bactericidal titers of the CSF were examined during therapy. Titers between 1:64 and 1:2,048, exceeding the minimal bactericidal concentration, were found. After five doses of cefmenoxime 50 mg/kg, two CSF cultures showed bacterial growth: one H. influenzae (bactericidal titer in CSF 1:256) and one S. pneumoniae.
Insights
Cefmenoxime effectively treats bacterial meningitis in children, achieving therapeutic cerebrospinal fluid (CSF) concentrations and bactericidal titers. This antibiotic shows promise for managing serious pediatric infections.
Area of Science:
- Pediatric Infectious Diseases
- Pharmacokinetics and Pharmacodynamics
- Bacterial Meningitis Treatment
Background:
- Bacterial meningitis remains a significant cause of childhood morbidity and mortality.
- Optimizing antibiotic therapy, including achieving adequate drug concentrations in the cerebrospinal fluid (CSF), is crucial for successful treatment.
- Cefmenoxime is a third-generation cephalosporin with broad-spectrum activity against common meningitis pathogens.
Purpose of the Study:
- To evaluate the pharmacokinetic profile of cefmenoxime in pediatric patients with bacterial meningitis.
- To assess the efficacy of cefmenoxime in achieving therapeutic CSF concentrations and bactericidal activity against causative pathogens.
- To determine the relationship between cefmenoxime dosage, CSF levels, and treatment outcomes.
Main Methods:
- Blood and CSF cefmenoxime concentrations were measured using microbiological assays and High-Performance Liquid Chromatography (HPLC).
- The study included 20 children diagnosed with or suspected of having bacterial meningitis.
- Bactericidal titers in CSF were determined in a subset of patients during therapy.
Main Results:
- Cefmenoxime CSF concentrations ranged from 0.9 to 12.2 mg/l, with a mean of 4.63 mg/l at 1.5-3 hours post-dose.
- Therapeutic CSF bactericidal titers (1:64 to 1:2,048) were observed in eight patients, indicating effective bacterial killing.
- Despite high CSF concentrations, two patients experienced positive CSF cultures, suggesting potential for treatment failure in some cases.
Conclusions:
- Cefmenoxime demonstrates favorable penetration into the CSF and achieves bactericidal concentrations in children with bacterial meningitis.
- The study highlights the importance of monitoring drug levels and bactericidal activity to ensure treatment efficacy.
- Further investigation may be warranted to optimize cefmenoxime dosing regimens and address potential treatment failures.