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Cefotaxime and aminoglycoside treatment of meningitis caused by gram-negative enteric organisms
1Myers Black Section of Pediatrics Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Abstract:
We reviewed cases of Gram-negative enteric bacillary meningitis in infants and children treated with cefotaxime at Texas Children's Hospital from January, 1984, through June, 1989. Seventeen of 20 children had an underlying condition predisposing to the development of meningitis. The etiologic organisms in these 20 children (2 days to 12 years old; median, 12 days old) were Klebsiella sp, 9; Escherichia coli, 4; Enterobacter cloacae, 3; Citrobacter diversus, 2; other, 2. With the exception of one isolate of Acinetobacter, all isolates were susceptible to cefotaxime. In addition to cefotaxime 17 children received an aminoglycoside intravenously. Children with meningitis caused by Klebsiella sp. or non-Klebsiella organisms received cefotaxime for 31 +/- 14 and 37 +/- 17 days, respectively. Aminoglycosides were administered for 16 +/- 10 days in both groups. Five children in each group also received intraventricular doses (1 to 25) of an aminoglycoside (9) or colistimethate (1). The mean durations of positive lumbar, ventricular cerebrospinal fluid or brain abscess cultures were 5.8 +/- 4.7 and 7.2 +/- 5.0 days after start of therapy in the Klebsiella and non-Klebsiella meningitis patients, respectively. Only three children were normal at the time of discharge or follow-up. Gram-negative enteric meningitis remains difficult to treat despite the excellent in vitro activity of cefotaxime against Gram-negative enterics, in part as a result of the predisposing conditions resulting in the development of this infection.
Insights
Cefotaxime showed excellent in vitro activity against Gram-negative enteric bacteria causing meningitis in children. However, outcomes remained poor due to underlying conditions and prolonged treatment durations.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Gram-negative enteric bacillary meningitis is a serious infection in infants and children.
- Underlying conditions often predispose children to this type of meningitis.
- Cefotaxime is an antibiotic with known in vitro activity against Gram-negative enterics.
Purpose of the Study:
- To evaluate the efficacy of cefotaxime in treating Gram-negative enteric bacillary meningitis in pediatric patients.
- To analyze treatment outcomes and identify factors influencing prognosis.
Main Methods:
- Retrospective review of pediatric cases treated with cefotaxime at Texas Children's Hospital (1984-1989).
- Analysis of causative organisms, susceptibility patterns, treatment regimens (including adjunct therapies), and clinical outcomes.
- Assessment of culture positivity duration and patient recovery status.
Main Results:
- Klebsiella sp. and Escherichia coli were the most common pathogens.
- All but one isolate were susceptible to cefotaxime.
- Despite treatment, only three children achieved normal outcomes at discharge or follow-up.
- Prolonged treatment durations were noted for both cefotaxime and aminoglycosides.
Conclusions:
- Gram-negative enteric meningitis remains challenging to treat in children, even with effective antibiotics like cefotaxime.
- Predisposing factors significantly contribute to the difficulty in achieving favorable outcomes.
- Further strategies are needed to improve the management of this severe pediatric infection.