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Imipenem/cilastatin treatment of bacterial meningitis in children
V K Wong1, H T Wright, L A Ross
1Department of Pediatrics, Children's Hospital of Los Angeles, USC School of Medicine 90027.
Abstract:
The safety and efficacy of imipenem/cilastatin were evaluated in 21 children, ages 3 to 48 months, with bacterial meningitis. Eradication of bacteria from the cerebrospinal fluid was demonstrated within 24 hours of antibiotic therapy in all but 2 patients who had Haemophilus influenzae type b meningitis and ultimately achieved bacteriologic cure after 2 to 3 days of imipenem/cilastatin therapy. Cerebrospinal fluid penetrations of imipenem and cilastatin were determined at various times after drug administration with mean cerebrospinal fluid: serum ratios of 14 and 10% for imipenem and cilastatin, respectively. The study was terminated when 7 (33%) patients developed seizure activity after antibiotic therapy was administered. The usefulness of imipenem/cilastatin for the treatment of bacterial meningitis in children may be limited by a possible increased incidence of drug-related seizure activity.
Insights
Imipenem/cilastatin showed efficacy in treating pediatric bacterial meningitis, clearing bacteria rapidly. However, a significant incidence of seizures limited its use, suggesting caution is needed.
Area of Science:
- Pediatric Infectious Diseases
- Neuropharmacology
Background:
- Bacterial meningitis remains a significant cause of morbidity and mortality in children.
- Effective antibiotic penetration into the cerebrospinal fluid (CSF) is crucial for treatment success.
Purpose of the Study:
- To evaluate the safety and efficacy of imipenem/cilastatin in children with bacterial meningitis.
- To assess CSF penetration of imipenem and cilastatin in this pediatric population.
Main Methods:
- A study involving 21 children aged 3–48 months with bacterial meningitis.
- Monitoring of bacterial eradication from CSF and assessment of drug concentrations in CSF and serum.
- Observation of adverse events, particularly seizure activity.
Main Results:
- Rapid CSF bacterial eradication was observed in most patients within 24 hours.
- CSF:serum ratios were 14% for imipenem and 10% for cilastatin.
- Seven patients (33%) experienced seizure activity, leading to study termination.
Conclusions:
- Imipenem/cilastatin demonstrates effectiveness in treating pediatric bacterial meningitis with rapid bacterial clearance.
- The high incidence of seizures suggests a potential limitation for imipenem/cilastatin use in this population.
- Further investigation into the risk of imipenem/cilastatin-induced seizures in children is warranted.