Cefotaxime therapy. Evaluation of its effect on bacterial meningitis, CSF drug levels, and bactericidal activity

Cefotaxime sodium was evaluated in the treatment of ten patients with bacterial meningitis. Seven of the patients were infected with unusual and difficult to eradicate pathogens. Eight of the ten patients had a favorable clinical response and rapid sterilization of their CSF. Trough CSF levels of cefotaxime (range, 5.6 to 44.3 micrograms/mL) and desacetylcefotaxime (3.7 to 44.0 micrograms/mL) were manyfold greater than the minimal bactericidal concentrations of the causative pathogens with the exception of the one Pseudomonas aeruginosa isolate. Trough CSF bactericidal titers ranged from 1:16 to 1:4,096 or more (median, 1:256) in the nine patients with susceptible pathogens. Trough cefotaxime and desacetylcefotaxime levels and bactericidal titers were maintained or actually increased over the course of therapy. Cefotaxime appears to be a promising new agent for the treatment of bacterial meningitis.