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Delayed cerebrospinal fluid sterilization, in vitro bactericidal activities, and side effects of selected
1Division of Infectious Diseases, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit.
Abstract:
Ampicillin (or penicillin G) plus chloramphenicol, cefuroxime, ceftriaxone, and cefotaxime have been used in the treatment of bacterial meningitis beyond the neonatal period. Review of recent data from the USA and Europe indicates that delayed CSF sterilization occurs significantly more often with ampicillin/chloramphenicol and cefuroxime than with ceftriaxone and cefotaxime. Delayed CSF sterilization is associated with an increased morbidity and neurological complications. Previously reported in vitro interactions between chloramphenicol and various beta-lactam antibiotics indicate that for bacteria where chloramphenicol is only bacteriostatic, the combination of chloramphenicol with beta-lactams is antagonistic. Killing rates of various beta-lactams were compared against a number of gram-positive and gram-negative bacteria. Cidal activity of some beta-lactams was inoculum dependent. There was a good correlation between in vitro activity and ability to sterilize CSF. Ceftriaxone is highly protein bound and its use in newborns is discouraged. Diarrhea occurs significantly more often after cefriaxone use than after the use of other agents. Ceftriaxone is uniquely associated with a high frequency of biliary pseudolithiasis which may be symptomatic and can cause measureable morbidity. In selecting the "proper" antimicrobial agent for the treatment of bacterial meningitis considerations should be given to proven clinical efficacy, prompt CSF sterilization, rapid in vitro cidal activity, safety and cost. We recommend cefotaxime as the agent of choice in the treatment of bacterial meningitis.
Insights
Cefotaxime is the recommended treatment for bacterial meningitis, offering faster cerebrospinal fluid (CSF) sterilization than ampicillin/chloramphenicol or cefuroxime. This leads to reduced neurological complications and improved patient outcomes.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Ampicillin, chloramphenicol, cefuroxime, ceftriaxone, and cefotaxime are used for bacterial meningitis treatment.
- Delayed cerebrospinal fluid (CSF) sterilization is linked to increased morbidity and neurological complications.
Purpose of the Study:
- To compare the efficacy of various antibiotics in achieving prompt CSF sterilization for bacterial meningitis.
- To evaluate the safety and clinical outcomes associated with different antibiotic regimens.
Main Methods:
- Review of recent data from the USA and Europe on antibiotic treatment for bacterial meningitis.
- Comparison of in vitro killing rates of beta-lactam antibiotics against gram-positive and gram-negative bacteria.
- Correlation analysis between in vitro activity and CSF sterilization ability.
Main Results:
- Ampicillin/chloramphenicol and cefuroxime showed significantly more delayed CSF sterilization compared to ceftriaxone and cefotaxime.
- In vitro studies indicated potential antagonism between chloramphenicol and beta-lactams.
- Ceftriaxone use was associated with increased diarrhea and biliary pseudolithiasis.
Conclusions:
- Cefotaxime demonstrates superior performance in achieving rapid CSF sterilization for bacterial meningitis.
- Considerations for antibiotic selection include efficacy, CSF sterilization, in vitro activity, safety, and cost.
- Cefotaxime is recommended as the agent of choice for treating bacterial meningitis.