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Intramuscular ceftriaxone versus ampicillin-chloramphenicol in childhood bacterial meningitis
N I Girgis1, A H Abu el Ella, Z Farid
1U.S. Naval Medical Research Unit No. 3, New York 09527.
Insights
Ceftriaxone (CFT) is effective for bacterial meningitis in children, simplifying treatment compared to ampicillin and chloramphenicol (AMC). This study shows CFT is a viable, easier-to-administer alternative for pediatric bacterial meningitis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Bacterial meningitis remains a significant cause of childhood morbidity and mortality.
- Current treatment regimens often involve complex dosing schedules and multiple antibiotics.
Purpose of the Study:
- To compare the efficacy and ease of administration of intramuscular ceftriaxone (CFT) versus combined ampicillin and chloramphenicol (AMC) for treating bacterial meningitis in children.
Main Methods:
- A randomized trial involving 70 children (4 months-12 years) with bacteriologically proven bacterial meningitis.
- Group 1 received once-daily intramuscular CFT (100 mg/kg).
- Group 2 received every 6-hourly intramuscular ampicillin (160 mg/kg/day) and chloramphenicol (100 mg/kg/day).
Main Results:
- 29 of 35 children in the CFT group recovered without complications, versus 26 of 35 in the AMC group.
- Mortality was lower in the CFT group (3 deaths) compared to the AMC group (7 deaths), particularly in patients not in deep coma at treatment initiation.
- CFT administration was significantly easier than the AMC regimen.
Conclusions:
- Intramuscular ceftriaxone is an effective and simpler treatment option for pediatric bacterial meningitis.
- The simplified dosing of CFT offers a practical advantage over the more complex AMC regimen.
- Ceftriaxone demonstrates comparable or improved outcomes with enhanced ease of administration in pediatric bacterial meningitis treatment.
Abstract:
70 children aged 4 months-12 years, with bacteriologically proven bacterial meningitis were treated with either intramuscular (IM) ceftriaxone (CFT) 100 mg/kg given once daily, or with combined IM ampicillin 160 mg/kg/day and IM chloramphenicol 100 mg/kg/day (AMC) given every 6 h. There were 35 children in each of the treatment groups. The children in both groups were comparable with regard to age, sex, duration of illness, and state of consciousness. 29 children in the CFT group and 26 in the AMC group recovered without any permanent complications or sequelae. Of the 15 children who died 10 (3 in the CFT and 7 in the AMC group) were in deep coma when treatment was started. Intramuscular CFT given once daily proved effective and much easier to administer than our standard hospital therapy with combined AMC given every 6 h IM.