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Cefotaxime therapy of bacterial meningitis in children
Insights
Cefotaxime is as safe and effective as standard treatment for childhood bacterial meningitis. This study found cefotaxime effective against ampicillin-resistant bacteria, showing promising results for treating this serious infection in children.
Area of Science:
- Pediatric Infectious Diseases
- Bacteriology
- Pharmacology
Background:
- Bacterial meningitis remains a significant cause of childhood morbidity and mortality.
- Antibiotic resistance, particularly to ampicillin, poses a challenge in treating bacterial meningitis.
- Evaluating novel antibiotic regimens is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the efficacy and safety of cefotaxime versus standard ampicillin and chloramphenicol therapy for bacterial meningitis in children.
- To assess the activity of cefotaxime against common bacterial meningitis pathogens, including ampicillin-resistant strains.
Main Methods:
- A randomized trial involving 30 children with bacterial meningitis.
- Patients received either ampicillin and chloramphenicol or cefotaxime (50 mg/kg/dose every 6 h) for 10-14 days.
- Cerebrospinal fluid isolates were identified, and antibiotic susceptibility testing was performed. Pharmacokinetic parameters and cerebrospinal fluid bactericidal titers were also assessed.
Main Results:
- Cefotaxime demonstrated activity against all tested isolates, including five ampicillin-resistant Haemophilus influenzae strains.
- Minimum inhibitory and bactericidal concentrations for cefotaxime were low, indicating potent antimicrobial activity.
- Cerebrospinal fluid bactericidal titers in the cefotaxime group were high (1:64 to 1:1024).
- Achieved cefotaxime and desacetyl-cefotaxime serum and cerebrospinal fluid concentrations were within therapeutic ranges.
- No adverse drug reactions were reported in either treatment group.
Conclusions:
- Cefotaxime is a safe and effective alternative to standard ampicillin and chloramphenicol therapy for bacterial meningitis in children.
- The drug's potent activity against common pathogens, including resistant strains, makes it a valuable therapeutic option.
Abstract:
Thirty children with bacterial meningitis were randomized to receive either ampicillin and chloramphenicol in standard doses or cefotaxime (50 mg/kg/dose every 6 h) for 10 to 14 days. Eighteen patients received ampicillin and chloramphenicol and 12 patients received cefotaxime. Cerebrospinal fluid isolated included: Haemophilus influenzae (20), Streptococcus pneumoniae (4), Neisseria meningitidis (3), Group B streptococcus (2), and Salmonella enteritidis (1). Five of the H. influenzae isolates were ampicillin resistant but no isolates were resistant to cefotaxime. The minimum inhibitory concentrations of cefotaxime for 30 isolates ranged from 0.0004 to 0.06 mg/l, while the minimum bactericidal concentrations ranged from 0.007 to 0.12 mg/l. The cerebrospinal fluid bactericidal titres for the cefotaxime-treated group ranged from 1:64 to 1:1024. On the second day of therapy the mean cefotaxime serum concentrations were 56.9 +/- 28.7 mg/l at 1 h and 3.66 +/- 5.65 mg/l at 6 h after administration of the drug whilst mean desacetyl-cefotaxime serum concentrations were 12.31 +/- 7.56 mg/l at one hour and 7.96 +/- 8.26 mg/l at 6 h respectively. Cerebrospinal fluid concentrations of cefotaxime and desacetylcefotaxime measured one hour after drug administration were 3.72 +/- 5.57 mg/l and 4.35 +/- 7.12 mg/l, respectively. No adverse drug reactions were noted in either treatment group. Cefotaxime proved to be both as safe and as efficacious as standard therapy for the treatment of bacterial meningitis in children.