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[Treatment of enterobacterial meningitis in adults with intravenous lamoxactam]
Abstract:
Meningitis caused by Gram-negative bacilli creates difficult problems since most strains are multiresistant. The purpose of this study was to evaluate the effectiveness of lamoxactam administered intravenously. Eleven patients admitted to an intensive care unit with meningitis due to Gram-negative bacilli were treated with this antibiotic, administered alone in 9 cases. Three patients had ventriculitis. Eight survived. The MICs ranged from 0.06 to 0.5 microgram/ml in 10 cases. The CSF was sterilized and rapidly became normal. Meningeal concentrations varied from 1-5 to 62 micrograms/ml and the CSF was bactericidal. In one female patient the CSF was sterile on the 5th day of treatment but remained abnormal; the meningeal concentration of lamoxactam (35 micrograms/ml) was much higher than the MIC (2 micrograms/ml) but below the MBC (128 micrograms/ml), which was consistent with the absence of bactericidal effect of the CSF. Owing to its very low CMIs and satisfactory passage through the blood-brain barrier, lamoxactam administered alone can be successful in the treatment of Gram-negative meningitis and ventriculitis. However, the bactericidal effect of the CSF should be rapidly assessed.
Insights
Lamoxactam effectively treats Gram-negative meningitis and ventriculitis, even when used alone. Rapid assessment of cerebrospinal fluid bactericidal effect is crucial for successful outcomes.
Area of Science:
- Infectious Diseases
- Pharmacology
- Neuroscience
Context:
- Gram-negative bacilli meningitis presents significant treatment challenges due to multidrug resistance.
- Intensive care unit (ICU) patients with Gram-negative meningitis require effective therapeutic options.
Purpose:
- To evaluate the efficacy of intravenous lamoxactam for treating meningitis caused by Gram-negative bacilli.
- To assess the cerebrospinal fluid (CSF) sterilization, bactericidal activity, and clinical outcomes.
Summary:
- Eleven ICU patients with Gram-negative meningitis received intravenous lamoxactam, with nine treated as monotherapy.
- Eight patients survived, and CSF sterilization was achieved rapidly in most cases.
- Therapeutic CSF concentrations of lamoxactam were achieved, demonstrating bactericidal activity in most instances.
Impact:
- Lamoxactam shows promise as a monotherapy for Gram-negative meningitis and ventriculitis due to its low critical meningitis infection (CMI) and good blood-brain barrier penetration.
- Monitoring CSF bactericidal effect is essential to ensure treatment success and prevent treatment failure.