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Aztreonam in the treatment of gram-negative bacterial meningitis
1Department of Medicine, Helene Fuld Medical Center, Trenton, New Jersey 08638.
Abstract:
Aztreonam was administered to 122 patients with presumptive or confirmed gram-negative bacillary meningitis in an open, multinational study. The antibiotic was administered at a dosage of 1-2 g to adults, 50 mg/kg to children greater than 2 years old, and 30 mg/kg to infants three or four times daily. Seventy-seven patients had microbiologically confirmed gram-negative meningitis due to an aztreonam-susceptible organism and received aztreonam for at least 48 hours. Haemophilus influenzae was the most frequently recovered pathogen (40 patients), followed by Enterobacteriaceae (16 patients), Neisseria meningitidis (15 patients), and Pseudomonas species (six patients). All but four patients were microbiologically cured. Microbiologic failure was associated with either a persistent intracerebral abscess (one patient) or a foreshortened course of therapy before microbiologic reevaluation and death (at 48 hours, 48 hours, and 72 hours after initiation of treatment, respectively). These data suggest that aztreonam is effective in the treatment of gram-negative bacillary meningitis caused by susceptible organisms.
Insights
Aztreonam effectively treated gram-negative bacillary meningitis in 122 patients. The antibiotic demonstrated high microbiologic cure rates, suggesting its efficacy against susceptible organisms.
Area of Science:
- Infectious Diseases
- Neuroscience
- Pharmacology
Background:
- Gram-negative bacillary meningitis poses a significant threat, particularly in vulnerable populations.
- Effective antibiotic therapy is crucial for improving patient outcomes and reducing mortality.
- Aztreonam is a monobactam antibiotic with activity against many Gram-negative bacteria.
Purpose of the Study:
- To evaluate the efficacy and safety of aztreonam in treating gram-negative bacillary meningitis.
- To assess the microbiologic cure rates and identify factors associated with treatment failure.
Main Methods:
- An open, multinational study involving 122 patients with presumptive or confirmed gram-negative bacillary meningitis.
- Aztreonam administered at specific dosages based on age (adults, children, infants).
- Microbiologic assessment of pathogens and treatment outcomes, including cure and failure rates.
Main Results:
- Seventy-seven patients with confirmed meningitis due to susceptible organisms received aztreonam for at least 48 hours.
- Haemophilus influenzae was the most common pathogen, followed by Enterobacteriaceae, Neisseria meningitidis, and Pseudomonas species.
- A high microbiologic cure rate was observed, with failures linked to intracerebral abscess or shortened therapy.
Conclusions:
- Aztreonam is effective in treating gram-negative bacillary meningitis caused by susceptible organisms.
- The study supports the use of aztreonam as a therapeutic option for this serious infection.
- Further investigation into managing treatment failures, such as those associated with abscesses, may be warranted.