Pefloxacin efficacy in gram-negative bacillary meningitis

Area of Science:

• Infectious Diseases
• Pharmacology
• Neurosurgery

Background:

• Acute meningitis caused by Gram-negative bacteria presents a significant clinical challenge, particularly in post-neurosurgical patients.
• Prior antibiotic therapies often fail in treating Gram-negative bacterial meningitis, necessitating alternative treatment strategies.

Purpose of the Study:

• To evaluate the efficacy and safety of intravenous pefloxacin for treating acute Gram-negative bacterial meningitis.
• To assess pefloxacin's pharmacokinetic profile, including cerebrospinal fluid penetration and minimum inhibitory/bactericidal concentrations (MIC/MBC).

Main Methods:

• A cohort of sixteen patients with Gram-negative bacterial meningitis received intravenous pefloxacin (800 mg twice daily).
• Causative organisms included Pseudomonas aeruginosa, Acinetobacter calcoaceticus, Klebsiella pneumoniae, and others.
• Cerebrospinal fluid (CSF) and serum concentrations of pefloxacin were measured, alongside MIC and MBC of the isolated bacteria.

Main Results:

• Pefloxacin achieved a mean CSF concentration of 8.8 mg/l, representing 54% of the mean peak serum concentration.
• Mean MIC and MBC values for causative organisms were 1.1 mg/l and 1.64 mg/l, respectively.
• Eighty-seven percent of patients showed clinical improvement or cure, and 80% achieved bacteriological cure, with no observed side effects.

Conclusions:

• Intravenous pefloxacin is an efficacious and safe treatment option for acute Gram-negative bacterial meningitis, especially in cases with prior treatment failure.
• Pefloxacin demonstrates adequate penetration into the cerebrospinal fluid, supporting its use in treating central nervous system infections.