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[Cefotaxime monotherapy in bacterial meningitis in childhood]
Abstract:
Bacterial meningitis in 20 children was treated with cefotaxime. 17 children received this antibiotic throughout the disease as monotherapy, three were changed to Penicillin G (2) or ampicillin (1), after sensitivity of the pathogen was known, although cefotaxime had been effective. All bacterial isolates were highly susceptible to cefotaxime. All CSF cultures were sterile at second tap, performed 24 to 48 hrs after therapy was started. Cefotaxime and desacetyl-cefotaxime concentrations in CSF, measured by HPLC in 9 patients were in the range of 4 to 34 (average 17.6) mg/l and 2.1 to 82 (average: 15.1) mg/l, representing a CSF-serum ratio of 8 to 74% (average 45.6%) for cefotaxime and 25 to 151% (average: 73.7%) for desacetyl-cefotaxime. Clinical outcome was favourable in 17 patients. There were one death and late neurological deficits in three. Cefotaxime monotherapy is recommended instead of standard therapy with chloramphenicol and/or ampicillin because of superior antibacterial activity, lower toxicity and lesser side-effects for primary meningitis in children caused by N. meningitides, S. pneumoniae, or H. influenzae type b.
Insights
Cefotaxime effectively treated bacterial meningitis in children, showing high susceptibility and favorable outcomes. This antibiotic is recommended over older treatments due to better efficacy and safety profiles.
Area of Science:
- Pediatric Infectious Diseases
- Pharmacology
- Microbiology
Context:
- Bacterial meningitis remains a significant cause of childhood morbidity and mortality.
- Current standard therapies like chloramphenicol and ampicillin have limitations regarding toxicity and resistance.
- Cefotaxime offers a promising alternative for treating pediatric meningitis.
Purpose:
- To evaluate the efficacy and safety of cefotaxime monotherapy in children with bacterial meningitis.
- To determine cefotaxime and desacetyl-cefotaxime concentrations in cerebrospinal fluid (CSF).
- To compare cefotaxime's effectiveness against common meningitis pathogens with existing treatments.
Summary:
- Twenty children with bacterial meningitis received cefotaxime; 17 as monotherapy.
- All bacterial isolates were highly susceptible to cefotaxime, with sterile CSF cultures within 48 hours of treatment initiation.
- CSF concentrations of cefotaxime and its metabolite desacetyl-cefotaxime were measured, showing favorable CSF-serum ratios.
- Clinical outcomes were favorable in 17 patients, with one death and three cases of neurological deficits.
Impact:
- Cefotaxime monotherapy demonstrates superior antibacterial activity and a better safety profile compared to chloramphenicol and ampicillin.
- This study supports the recommendation of cefotaxime as a primary treatment for pediatric meningitis caused by common pathogens.
- The findings suggest reduced toxicity and fewer side effects, improving patient outcomes in pediatric meningitis treatment.