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[Cefotaxime CSF levels in children with purulent meningitis (author's transl)]
Insights
Cefotaxime effectively treats bacterial meningitis in children, achieving high cerebrospinal fluid (CSF) concentrations. These levels exceed the minimum inhibitory concentrations (MICs) of common pathogens, offering superior antibacterial activity.
Area of Science:
- Pharmacology
- Infectious Diseases
- Pediatrics
Context:
- Bacterial meningitis remains a significant cause of morbidity and mortality in children.
- Cerebrospinal fluid (CSF) penetration is crucial for effective antibiotic therapy in meningitis.
- Previous studies suggest cefotaxime's potential in treating bacterial meningitis.
Purpose:
- To evaluate cefotaxime concentrations in the CSF of pediatric patients with bacterial meningitis.
- To compare achieved cefotaxime CSF levels with the minimum inhibitory concentrations (MICs) of causative pathogens.
- To assess cefotaxime's efficacy against specific bacteria, including Haemophilus influenzae and enterobacteriaceae.
Summary:
- Cefotaxime monotherapy was administered to twelve children with bacterial meningitis.
- CSF cefotaxime concentrations peaked within one hour post-injection (3-19 mcg/ml) and remained elevated for five hours (1.8-14.3 mcg/ml).
- Achieved CSF concentrations were significantly higher than the MICs of isolated pathogens, including Serratia marcescens, Proteus mirabilis, Enterobacter cloacae, Escherichia coli, Salmonella panama, Haemophilus spp., Klebsiella pneumoniae, and Pseudomonas aeruginosa.
Impact:
- Cefotaxime demonstrates excellent CSF penetration and sustained therapeutic concentrations in pediatric bacterial meningitis.
- Achieved concentrations provide potent antibacterial activity, surpassing ampicillin's efficacy against key meningitis-causing bacteria.
- These findings support cefotaxime as a valuable therapeutic option for bacterial meningitis in pediatric populations.
Abstract:
Cefotaxime concentrations obtained in the C.S.F. of twelve children suffering from bacterial meningitis and undergoing monotherapy with this antibiotic are reported. Among these 12 patients, 4 infants (aged 3 to 28 days) had neonatal meningitis (due to Serratia marcescens, Proteus mirabilis, Enterobacter cloacae, Escherichia coli); one infant (2 months old) had meningitis due to Salmonella panama; 5 children (aged 5 to 11 months) had meningitis due to Haemophilus; and 2 children had belated superinfection caused by a ventriculo-peritoneal shunt due to Klebsiella pneumoniae and Pseudomonas aeruginosa. Cefotaxime concentration reached a high level as early as one hour after the injection (3 to 19 mcg/ml), remained at this level until the fifth hour (1,8 to 14,3 mcg/ml) and decreased without significant proportionality with the disappearance of the inflammatory symptoms. Compared to the M.I.C. of the bacteria which caused the twelve cases of meningitis, these results show that the concentrations in the C.S.F. are much higher than the M.I.C.'s. These results are comparable to those of previous studies. Cefotaxime diffuses in the C.S.F. and gives concentrations which ensures an antibacterial activity that ampicillin could not reach: in particular against Haemophilus influenzae and enterobacteriaceae.