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Cefotaxime monotherapy of bacterial meningitis caused by gram-positive pathogens
Abstract:
Primary meningitis in children is caused by two gram-negative bacterial species, Neisseria meningitidis and Haemophilus influenzae, and one gram-positive bacterial species Streptococcus pneumoniae. Despite optimal penicillin susceptibility, with few exceptions, therapeutic results in pneumococcal meningitis are by far worse than with the other two pathogens. Therefore, and because of the detection of penicillin-resistant rods, the study of alternatives in therapy is justified and was started with cefotaxime. Including six of our own patients, there are reports on 87 patients in the literature suffering from S. pneumoniae meningitis who were treated with cefotaxime monotherapy. Results of these studies will be analyzed. As none of these patients belonged to a prospective controlled study group, final evaluation in comparison with penicillin therapy remains open. There are also several reports on successful treatment of group B streptococcus meningitis with cefotaxime, although there is no need to abandon penicillin therapy. Staphylococcus aureus and Staphylococcus epidermidis meningitis, usually secondary in shunted hydrocephalus, brain tumors, brain injury or other causes, should not be treated with cefotaxime because of its limited activity on these bacteria. Listeria monocytogenes and Streptococcus faecalis are primarily cefotaxime-resistant, and neonatal meningitis of unknown origin, therefore, should not be treated with cefotaxime alone as long as these pathogens cannot be excluded.
Insights
Cefotaxime shows promise for treating Streptococcus pneumoniae meningitis in children, offering an alternative when penicillin therapy is less effective. Further controlled studies are needed to compare its efficacy against penicillin.
Area of Science:
- Pediatric Infectious Diseases
- Bacterial Meningitis Pathogenesis
- Antibiotic Therapy Research
Background:
- Primary bacterial meningitis in children is commonly caused by Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae.
- Despite Streptococcus pneumoniae's penicillin susceptibility, treatment outcomes are often poorer compared to other meningitis pathogens.
- Emergence of penicillin-resistant strains necessitates exploring alternative therapeutic agents.
Purpose of the Study:
- To evaluate the efficacy of cefotaxime as a monotherapy for Streptococcus pneumoniae meningitis in pediatric patients.
- To analyze existing literature on cefotaxime treatment for S. pneumoniae meningitis.
- To assess the suitability of cefotaxime for other types of bacterial meningitis.
Main Methods:
- Literature review and analysis of reported cases of cefotaxime monotherapy for S. pneumoniae meningitis.
- Inclusion of six original patient cases treated with cefotaxime.
- Examination of clinical outcomes and comparison with historical data.
Main Results:
- Analysis of 87 reported cases (including six original cases) of S. pneumoniae meningitis treated with cefotaxime monotherapy.
- Cefotaxime has shown successful treatment in some cases of group B Streptococcus meningitis.
- Cefotaxime demonstrates limited activity against Staphylococcus aureus, Staphylococcus epidermidis, Listeria monocytogenes, and Streptococcus faecalis.
Conclusions:
- Cefotaxime monotherapy is a potential alternative for treating Streptococcus pneumoniae meningitis, particularly when penicillin efficacy is a concern.
- Further prospective, controlled studies are required to definitively compare cefotaxime with penicillin therapy for pneumococcal meningitis.
- Cefotaxime is not recommended as a sole agent for neonatal meningitis of unknown origin due to resistance in certain pathogens like Listeria monocytogenes and Streptococcus faecalis.