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[Treatment of purulent meningitis in the child using Cefotaxime]
Abstract:
Cefotaxime has a good meningeal diffusion and is effective at low concentrations on many bacteria, especially ampicillin resistant Enterobacteriaceae and Hemophilus influenzae. We have therefore used cefotaxime (150 mg/kg/24 h, continuous infusions lasting 30 minutes q. 6 h.) in meningitis due to gram negative bacilli. Twenty eight infants and children have been treated within 4 years. The 13 Hemophilus influenzae meningitis (including 2 beta-lactamase producers) have been cured without immediate sequelae. The duration of treatment could be reduced from 3 weeks to 2 weeks. The 7 infants with Enterobacteria meningitis (6 E. coli and 1 Serratia) have been cured of their infection with a 21 to 28 days treatment. The C.S.F. was sterile 2-3 days after treatment except a case of E. coli persisting during 7 days in C.S.F. contrasting with a normal ventricular fluid. A case of relapse with E. coli remaining sensitive was cured with a new course of the same treatment. Five meningitis complicated with hydrocephalus needed external drainage: the fluid was sterile 1 day after treatment in 4 of them. Two superinfections of ventriculo-peritoneal shunt due to Enterobacteriaceae have been cured. To obtain a good result, the need for a careful drug monitoring must be emphasized.
Insights
Cefotaxime effectively treats gram-negative bacillary meningitis in children, including resistant strains. This antibiotic offers a reduced treatment duration and good outcomes for various bacterial meningitis cases.
Area of Science:
- Infectious Diseases
- Pediatrics
- Pharmacology
Context:
- Bacterial meningitis, particularly gram-negative bacillary meningitis, poses a significant threat to infants and children.
- Cefotaxime demonstrates excellent penetration into the cerebrospinal fluid (CSF).
- Ampicillin-resistant Enterobacteriaceae and Hemophilus influenzae are common causative agents of meningitis.
Purpose:
- To evaluate the efficacy and safety of cefotaxime in treating meningitis caused by gram-negative bacilli in pediatric patients.
- To assess the optimal dosage and administration of cefotaxime for pediatric meningitis.
- To determine the impact of cefotaxime on treatment duration and patient outcomes.
Summary:
- Cefotaxime was administered at 150 mg/kg/24 h via continuous infusion every 6 hours to 28 pediatric patients with gram-negative bacillary meningitis.
- Excellent clinical outcomes were observed in 13 cases of Hemophilus influenzae meningitis and 7 cases of Enterobacteriaceae meningitis, with reduced treatment durations.
- The study highlights the effectiveness of cefotaxime in treating complicated meningitis, including hydrocephalus and ventriculo-peritoneal shunt infections, emphasizing the need for drug monitoring.
Impact:
- Cefotaxime offers a viable and effective treatment option for pediatric gram-negative bacillary meningitis, including resistant strains.
- The study supports a potential reduction in the duration of antibiotic therapy for certain types of meningitis.
- Findings underscore the importance of therapeutic drug monitoring for optimizing cefotaxime treatment in pediatric meningitis.