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Intrathecal gentamicin for refractory gram-positive meningitis
Abstract:
The mortality for meningitis due to Staphylococcus aureus or Listeria monocytogenes remains high, ranging from 32% to 77%. We treated a patient with staphylococcal meningitis refractory to methicillin sodium and oxacillin sodium, and a patient with Listeria meningitis refractory to penicillin G potassium and ampicillin sodium; both patients were cured when intrathecal gentamicin sulfate was added to the regimen. The combination of intrathecal gentamicin and a penicillin may be beneficial in refractory staphylococcal or Listeria meningitis.
Insights
High mortality rates for Staphylococcus aureus and Listeria meningitis persist. Intrathecal gentamicin sulfate successfully treated two refractory meningitis cases, suggesting its benefit in combination therapy for resistant infections.
Area of Science:
- Infectious Diseases
- Neurology
- Pharmacology
Background:
- Meningitis caused by Staphylococcus aureus and Listeria monocytogenes is associated with significant mortality.
- Standard antibiotic regimens for these infections can be refractory, posing treatment challenges.
Observation:
- Two patients with refractory meningitis were treated: one with Staphylococcus aureus and one with Listeria monocytogenes.
- The staphylococcal meningitis case was refractory to methicillin and oxacillin sodium.
- The Listeria meningitis case was refractory to penicillin G potassium and ampicillin sodium.
Findings:
- Both patients achieved a cure after the addition of intrathecal gentamicin sulfate to their existing treatment regimens.
- Intrathecal gentamicin sulfate demonstrated efficacy in treating severe, antibiotic-resistant meningitis.
Implications:
- The combination of intrathecal gentamicin and a penicillin antibiotic may represent a beneficial therapeutic strategy for refractory staphylococcal or Listeria meningitis.
- This approach could improve outcomes for patients with severe, difficult-to-treat meningitis.
- Further investigation into intrathecal gentamicin for resistant meningitis is warranted.