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Ciprofloxacin in the treatment of gram-negative bacillary meningitis
1University Hospital of Infectious Disease, Zagreb, Yugoslavia.
Abstract:
Gram-negative bacillary meningitis (typically caused by E. coli, K. pneumoniae, P. aeruginosa, A. calcoaceticus, and others) has been associated with head trauma, neurosurgical operations, pathologic anastomosis with nasal cavity, and CSF rhinorrhea, as well as with impaired host defenses. Intravenous ciprofloxacin was given to 20 patients with gram-negative bacillary meningitis. The dose of ciprofloxacin was 200 mg by intravenous infusion, over 30 minutes, every 12 hours for 10 days. Two patients also received intravenous cefotaxime and penicillin G. All patients were monitored daily. Of 20 patients, 18 had cure and therapy failed in two. Because relatively low concentrations of ciprofloxacin are achieved in the CSF, the drug should be used in the treatment of gram-negative bacillary meningitis only if the MICs of the causative pathogen and the ciprofloxacin concentration in CSF can be followed. A randomized, controlled study is needed to compare the efficacy of intravenous ciprofloxacin with standard antibiotic therapy in the treatment of this disease.
Insights
Ciprofloxacin shows promise for treating Gram-negative bacillary meningitis, with 18 of 20 patients cured. However, careful monitoring of minimum inhibitory concentrations (MICs) and cerebrospinal fluid (CSF) drug levels is crucial due to low CSF penetration.
Area of Science:
- Infectious Diseases
- Neuroscience
- Pharmacology
Background:
- Gram-negative bacillary meningitis is a serious infection often linked to head trauma, neurosurgery, or impaired immunity.
- Common causative agents include E. coli, K. pneumoniae, and P. aeruginosa.
Purpose of the Study:
- To evaluate the efficacy and safety of intravenous ciprofloxacin in treating Gram-negative bacillary meningitis.
- To assess the outcomes of ciprofloxacin therapy in a cohort of affected patients.
Main Methods:
- Twenty patients diagnosed with Gram-negative bacillary meningitis received intravenous ciprofloxacin (200 mg every 12 hours for 10 days).
- Two patients also received cefotaxime and penicillin G.
- Daily monitoring was conducted for all participants.
Main Results:
- A cure was achieved in 18 out of 20 patients.
- Therapy failed in two patients.
- Low concentrations of ciprofloxacin in cerebrospinal fluid (CSF) were noted.
Conclusions:
- Intravenous ciprofloxacin demonstrated a high cure rate for Gram-negative bacillary meningitis.
- Its use should be contingent on monitoring pathogen minimum inhibitory concentrations (MICs) and CSF drug levels due to limited CSF penetration.
- Further randomized controlled trials are necessary to compare ciprofloxacin with standard antibiotic treatments.