cefepime and Meningitis--Bacterial

A 64-year-old man with fever, appetite loss, and pain in the back of the neck visited our hospital. We diagnosed him as having bacterial meningitis because of pleocytosis of the cerebrospinal fluid, and started treatment with antibiotics. Multiple cerebral infarcts were found on brain MRI. We suspected that the origin of the bacterial meningitis was infective endocarditis, and administered Cefepime and Gentamicin according to the guidelines for treatment of infective endocarditis. Three days later, he became drowsy and had myoclonus and flapping of the extremities. An electroencephalograph showed generalized periodic discharge and a triphasic wave pattern. We thought that the cause of disturbance in consciousness was Cefepime-induced encephalopathy, and stopped administration of Cefepime. A few days later, he became clear, and the myoclonus and flapping disappeared. It was difficult to distinguish between non-convulsive status epilepticus and Cefepime-induced encephalopathy. However, since stopping Cefepime treatment had made the patient clear, we diagnosed his condition as Cefepime-induced encephalopathy, which often occurs in patients with renal or liver dysfunction, or in brain infarction or meningitis, which results in blood-brain barrier disruption. Thus, care should be taken when administering Cefepime to such patients.

Topics: Anti-Bacterial Agents; Brain Diseases; Cefepime; Cephalosporins; Diagnosis, Differential; Electroencephalography; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Middle Aged; Status Epilepticus

Chryseobacterium meningosepticum is an uncommon pathogen causing adult bacterial meningitis. Herein, we report the case history of one 21-year-old woman with this uncommon central nervous system infection. A diagnosis of adult C. meningosepticum meningitis can only be confirmed by a positive cerebrospinal fluid (CSF) culture. The patient had insulin-dependent diabetes mellitus as the underlying condition associated with this infection. The clinical presentations were fever, headache, consciousness disturbance, and seizure. CSF analysis revealed a purulent inflammatory reaction. After a 21-day course of intravenous cefepime (6 g/day) treatment, this patient was discharged in a state of complete recovery.

Topics: Adult; Anti-Bacterial Agents; Cefepime; Cephalosporins; Chryseobacterium; Female; Flavobacteriaceae Infections; Humans; Meningitis, Bacterial

Because determining the pharmacokinetics of drugs used in pediatric patients allows for appropriate dosing and optimal clinical response, we have reviewed the pharmacokinetic data on the use of cefepime in the pediatric population.. Three studies encompassing 88 patients ages 2 months to 16 years examined the pharmacokinetics of cefepime given as a single iv dose, as multiple iv doses and by im administration. In all studies serial blood and urine or cerebrospinal fluid (CSF) samples were collected after a single dose and/or at steady state, defined as after at least 2 days of dosing. Pharmacokinetic parameters were generated from concentration-vs.-time curves and were analyzed using noncompartmental methods.. In all studies cefepime exhibited a linear pharmacokinetic profile and concentrations declined proportionally over time. Minimal accumulation was observed after multiple dosing. Pharmacokinetic parameters were similar in all studies and appeared to be dose-independent. Mean (range) parameters observed in this review were: t 1/2 = 1.7 h (1.26 to 1.93); volume of distribution at steady state, 0.37 liter/kg (0.33 to 0.40); total body clearance, 3.1 ml/min/kg (1.43 to 4.01); renal total body clearance, 2.3 ml/min/kg (1.86 to 3.05); absolute bioavailability of cefepime after the im dose, 82.3%; and urinary recovery, 72% (57 to 85%). Penetration into CSF appeared to be good, with CSF concentrations averaging 3.3 to 5.7 microg/ml 0.5 and 8 h after administration of the dose, respectively.. Cefepime displayed a linear pharmacokinetic profile, was well-absorbed via im injection and had adequate penetration into the CSF of patients with bacterial meningitis, compared with other beta-lactams.

Topics: Adolescent; Cefepime; Cephalosporins; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Humans; Infant; Injections, Intramuscular; Injections, Intravenous; Male; Meningitis, Bacterial; Safety; Time Factors; Treatment Outcome

Because the introduction of extended spectrum cephalosporins into pediatric practice offers a number of choices for treatment, we review efficacy studies of cefepime monotherapy in the treatment of bacterial meningitis in children.. Two open, randomized, comparative studies assessed the efficacy of cefepime empiric monotherapy in the treatment of bacterial meningitis in 345 pediatric patients. These studies were conducted in Latin America and compared cefepime (50 mg/kg/dose every 8 h) with either cefotaxime (50 mg/kg/dose every 6 h) or ceftriaxone (50 mg/kg/dose every 12 h). Patients 2 months to 14 years old who had clinical signs and symptoms consistent with a central nervous system infection were enrolled. Efficacy was based on clinical and bacteriologic response.. Integrated results from the Latin American studies indicated a 75% cure rate with cefepime vs. a 78% cure rate with comparator, among evaluable patients. Overall the rate of treatment failure was 12%. Haemophilus influenzae had the highest bacterial eradication rate (97% overall), and rates were comparable in cefepime and comparator arms. Eradication rates for Neisseria meningitidis were equally high in both treatment arms (95% overall), and the eradication rate for Streptococcus pneumoniae was 92% overall. Of the patients with S. pneumoniae isolated during pretreatment (from either cerebrospinal fluid or blood), 11 (16 isolates in total) had their isolates tested against penicillin and all were susceptible. Presence or absence of seizures, level of consciousness, Glasgow Coma Score and duration of signs and symptoms were strong predictors of outcome. Collectively no specific safety concerns were identified.. Cefepime represents an important therapeutic option for the empiric treatment of bacterial meningitis in children, based on the good clinical response and bacteriologic eradication rates observed in this review.

Topics: Adolescent; Cefepime; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Humans; Infant; Latin America; Meningitis, Bacterial; Randomized Controlled Trials as Topic; Safety; Treatment Failure; Treatment Outcome

Three broad-spectrum antibiotics are reviewed, each from a different class. Meropenem is closely related to imipenem and was recently approved for use in children. Its advantages over imipenem include greater activity against gram-negative bacteria and lack of association with seizures. Cefepime is a fourth generation cephalosporin with the gram-positive activity of cefotaxime and the gram-negative spectrum of ceftazidime. Trovafloxacin is a fluoroquinolone with an exceptionally broad antibacterial spectrum. Meropenem is approved for use in children, cefepime is approved for use in adults only, and trovafloxacin is still undergoing clinical trials. These agents should be reserved for treatment of serious infections, especially those in immunocompromised patients or polymicrobial infections.

Topics: Anti-Infective Agents; Cefepime; Cephalosporins; Child; Fluoroquinolones; Humans; Meningitis, Bacterial; Meropenem; Naphthyridines; Thienamycins

Cefepime and cefpirome are new beta-lactamase resistant parenteral cephalosporin derivatives whose spectrum of activity makes them suitable for use in the treatment of severe infections such as bacterial meningitis. However, the published information on the penetration of these new agents into human CSF and on their use in the treatment of bacterial meningitis are really scarce. Experimental studies have shown that cefepime and cefpirome penetrated remarkably well into the CSF of animals infected with Streptococcus pneumoniae, Streptococcus agalactiae, Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae type b or Pseudomonas aeruginosa. The mean changes in bacterial colony count in CSF after cefpirome or cefepime administration express the antibacterial activity of these drugs. Studies in patients show that cefepime and cefpirome crossed the blood-brain barrier and reached concentrations in the CSF that are bactericidal against most potential pathogens. Higher levels are likely to be achieved with multiple dosing and in the presence of inflamed meninges. No study has been performed to investigate the efficacy of cefpirome in the treatment of bacterial meningitis. Cefepime was as effective and safe as cefotaxime for treatment of patients with bacterial meningitis as shown in the only clinical trial.

Topics: Animals; Blood-Brain Barrier; Cefepime; Cefpirome; Cephalosporins; Clinical Trials as Topic; Humans; Meningitis, Bacterial; Microbial Sensitivity Tests

Topics: Anti-Bacterial Agents; Cefepime; Cephalosporins; Cross Infection; Dominican Republic; Female; Humans; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Klebsiella pneumoniae; Male; Meningitis, Bacterial

Ninety infants and children were prospectively randomized to receive cefepime (n = 43) or cefotaxime (n = 47) for therapy of bacterial meningitis. The two treatment groups were comparable in terms of age, duration of illness before enrollment, history of seizures, clinical status on admission, and etiology. Six (7%) patients died--two treated with cefepime and four treated with cefotaxime. Clinical response, cerebrospinal fluid sterilization, development of complications, antibiotic toxicity, and hospital stay were similar for the two treatment regimens. Concentrations of cefepime in cerebrospinal fluid varied from 55 to 95 times greater than the maximal MIC required by the causative pathogens. Audiologic and/or neurologic sequelae were found in 16% of the cefepime-treated patients and 15% of the cefotaxime-treated patients examined 2 to 6 months after discharge. We conclude that cefepime is safe and therapeutically equivalent to cefotaxime for management of bacterial meningitis in infants and children.

Topics: Adolescent; Cefepime; Cefotaxime; Cephalosporins; Child; Child, Preschool; Humans; Infant; Meningitis, Bacterial; Prospective Studies

This study aimed to determine the bacteriological profile of childhood acute bacterial meningitis in Pakistan.. The study included a total of 100 children aged between 1 month and 5 years, who were admitted with a diagnosis of meningitis based on clinical findings and positive cerebrospinal fluid (CSF) tests. Out of the 100 CSF samples collected, 21 isolates were confirmed to contain Enterobacteriaceae. The most prevalent Enterobacteriaceae species were Pseudomonas (n=8, 38.09%), Klebsiella (n=4, 19.04%), E. coli (n=4, 19.04%), and Acinetobacter (n=4, 19.04%), while Citrobacter (n=1, 4.76%) was less common. Antibiotic susceptibility patterns were analyzed for these isolates.. Pseudomonas (n=8) exhibited 25% resistance to cefepime and 38% resistance to imipenem. Klebsiella (n=4) showed 75% resistance to imipenem. Acinetobacter (n=4) demonstrated 50% resistance to imipenem, along with varying resistance to cefepime, amikacin, ciprofloxacin, and gentamicin. E. coli (n=4) showed 0% resistance to imipenem and amikacin. However, Citrobacter (n=1) showed 0% resistance to ciprofloxacin, aztreonam, gentamicin, amikacin, levofloxacin, and cefepime. Acute bacterial meningitis primarily affects children under 1 year of age.. CSF culture revealed that Gram-negative bacteria, specifically Pseudomonas spp., were the predominant pathogens in this family based on Pakistani data.

Topics: Amikacin; Anti-Bacterial Agents; Cefepime; Child; Ciprofloxacin; Drug Resistance, Bacterial; Enterobacteriaceae; Escherichia coli; Gentamicins; Gram-Negative Bacteria; Humans; Imipenem; Infant; Infant, Newborn; Meningitis, Bacterial; Microbial Sensitivity Tests; Tertiary Care Centers

Cefepime is administered as an intermittent infusion (II); however, continuous infusion (CI) may be advantageous because β-lactam antibiotics exhibit time-dependent antibacterial activity. This retrospective, non-randomised, comparative study included 68 neurosurgical patients with post-operative intracranial infections treated with 4g/day cefepime over 24h as a CI (n=34) or 2g every 12h as II (n=34). CI controlled the intracranial infection more rapidly and effectively than II (6.6±1.9 days vs. 7.8±2.6 days; P=0.036). By considering the minimum inhibitory concentrations (MICs) to be 4μg/mL and 8μg/mL, the percentage of time when the cefepime plasma or CSF concentrations were higher than the MIC (%T>MIC) was calculated for each patient. For plasma cefepime concentrations, the %T(>MIC) in the CI group was higher than in the II group (for MICs of 8μg/mL, 100% vs. 75%, respectively). The mean calculated area under the curve (AUC) in the CI group was similar to the II group (1197.99±72.15μgh/mL vs. 890.84±140.78μgh/mL; P=0.655). For CSF cefepime concentrations, the %T(>MIC) in the CI group was higher than in the II group (for MICs of 4μg/mL and 8μg/mL, 83.3% and 75% vs. 25% and 0%, respectively). The mean calculated AUC for the CI group was higher than the II group (220.56±13.59μgh/mL vs. 86.34±5.69μgh/mL; P=0.003). Therefore, CI of cefepime significantly enhanced the antibacterial effect and reduced the treatment duration in neurosurgical patients with post-operative intracranial infections.

Topics: Adult; Aged; Anti-Bacterial Agents; Cefepime; Cephalosporins; Female; Humans; Infusions, Intravenous; Male; Meningitis, Bacterial; Middle Aged; Neurosurgical Procedures; Plasma; Postoperative Complications; Retrospective Studies

In this study the efficacy of doripenem, a new broad-spectrum carbapenem, was tested against an Escherichia coli strain and a Klebsiella pneumoniae strain in an experimental animal model. The comparator was cefepime monotherapy.. The rabbit meningitis model was used in this study and the penetration of doripenem through uninflamed and inflamed meninges was determined.. Doripenem, injected three times (75 mg/kg), led to serum peak levels around 100 mg/L and trough levels around 5 mg/L, resulting in a penetration rate of 14% through inflamed meninges and 7% through uninflamed meninges. Against K. pneumoniae, doripenem was slightly but not significantly more efficacious than cefepime over 8 h (5.40 ± 1.37 log(10) cfu/mL versus 3.59 ± 0.89 log(10) cfu/mL for cefepime). Also against the E. coli strain doripenem was slightly superior to the comparator (5.55 ± 0.87 log(10) cfu/mL versus 3.80 ± 1.10 log(10) cfu/mL for cefepime), although the difference was not significant.. Doripenem is a potential monotherapy for the treatment of meningitis due to Gram-negative microorganisms.

Topics: Animals; Anti-Bacterial Agents; Bacterial Load; Carbapenems; Cefepime; Cephalosporins; Disease Models, Animal; Doripenem; Escherichia coli; Escherichia coli Infections; Klebsiella Infections; Klebsiella pneumoniae; Meningitis, Bacterial; Rabbits; Treatment Outcome

Topics: Acinetobacter baumannii; Adolescent; Adult; Aged; Amikacin; Anti-Bacterial Agents; Carbapenems; Cefepime; Cefoperazone; Cephalosporins; Ciprofloxacin; Drug Resistance, Bacterial; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Imipenem; Male; Meningitis, Bacterial; Meropenem; Microbial Sensitivity Tests; Middle Aged; Neurosurgical Procedures; Postoperative Complications; Thienamycins; Turkey

A simple MEKC with UV detection at 214 nm for simultaneous analysis of cefepime and vancomycin in plasma and in cerebrospinal fluid (CSF) by direct injection without any sample pretreatment is described. The separation of cefepime and vancomycin from biological matrices was performed at 25 degrees C using a BGE consisting of a Tris buffer with SDS and methanol as the electrolyte solution. Under optimal MEKC conditions for biological samples, good separations with high efficiency and short analysis time are achieved. Several parameters affecting the separation of the drugs from biological matrices were studied, including methanol, pH, and concentrations of the Tris buffer and SDS. The linear ranges of the method for the determination of cefepime and vancomycin in plasma and in CSF using imidazole or cefazolin as an internal standard, respectively, were all over the range of 1-30 microg/mL; the detection limits of cefepime and vancomycin in biological matrices (injection 10 kV, 15 s) were 0.3 and 0.5 microg/mL, respectively. The applicability of the proposed method for the determination of cefepime and vancomycin in plasma and CSF collected after intravenous administration of the drugs in patients with meningitis was demonstrated.

Topics: Buffers; Cefepime; Cephalosporins; Chromatography, Micellar Electrokinetic Capillary; Humans; Hydrogen-Ion Concentration; Meningitis, Bacterial; Sodium Dodecyl Sulfate; Tromethamine; Vancomycin

Pseudomonas aeruginosa is a rare cause of infective endocarditis. The case of community-acquired P. aeruginosa infective endocarditis reported here is the first described in the literature to present as bacterial meningitis. Furthermore, new risk factors for P. aeruginosa infective endocarditis, including mitral annular calcification and re-use of insulin syringes, are proposed. Treatment of P. aeruginosa infective endocarditis complicated by bacterial meningitis is discussed.

Topics: Acyclovir; Ampicillin; Calcification, Physiologic; Cefepime; Cephalosporins; Community-Acquired Infections; Diagnosis, Differential; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Gentamicins; Humans; Meningitis, Bacterial; Middle Aged; Pseudomonas aeruginosa; Pseudomonas Infections; Risk Factors; Vancomycin

Transrectal prostate biopsy is the most accurate method for prostate cancer diagnosis. Although an antimicrobial prophylaxis is employed in most cases, infectious complications are among the most severe. We present a case of E. coli multirresistant meningitis after transrectal prostate biopsy despite quinolone prophylaxis.

Topics: Aged; Amoxicillin; Biopsy; Brain Damage, Chronic; Cefepime; Cephalosporins; Ciprofloxacin; Clavulanic Acid; Confusion; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Male; Meningitis, Bacterial; Premedication; Prostate; Rectum; Ultrasonography; Vancomycin

Gatifloxacin penetrated well into cerebrospinal fluid (CSF) (49 +/- 11%), measured by comparison of AUC(CSF)/AUC(serum), and showed good bactericidal activity (leading to a decrease of 0.75 +/- 0.17 log10 cfu/mL/h) in the treatment of experimental meningitis in rabbits caused by a penicillin-resistant pneumococcal strain (MIC 4 mg/L). It was significantly more effective than the standard regimen, ceftriaxone with vancomycin, which led to a decrease of 0.53 +/- 0.17 log10 cfu/mL/h. The addition of cefepime to gatifloxacin slightly improved the killing rates (giving a decrease of 0.84 +/- 0.14 log10 cfu/mL/h). In vitro, synergy was demonstrated between cefepime and gatifloxacin by the chequerboard method (fractional inhibitory concentration index = 0.5) and by viable counts over 8 h.

Topics: Animals; Anti-Infective Agents; Cefepime; Cephalosporins; Disease Models, Animal; Drug Therapy, Combination; Fluoroquinolones; Gatifloxacin; Meningitis, Bacterial; Microbial Sensitivity Tests; Penicillin Resistance; Rabbits; Streptococcus pneumoniae; Treatment Outcome

Topics: Adolescent; Arnold-Chiari Malformation; Cefepime; Cephalosporins; Enterobacter aerogenes; Enterobacteriaceae Infections; Humans; Meningitis, Bacterial; Neurosurgical Procedures; Postoperative Complications

Nonconvulsive status epilepticus is an unusual complication of cephalosporin therapy, with only a few isolated cases reported.. We reviewed the clinical and electroencephalographic (EEG) characteristics of 10 patients with renal failure in whom developed alteration of consciousness without convulsions associated with continuous epileptiform EEG activity while being treated with cephalosporins.. Nonconvulsive status epilepticus developed in 5 men and 5 women, with a mean (+/- SD) age of 69 +/- 14 years, while receiving intravenous cephalosporins (ceftriaxone, 2 patients; ceftazidime, 2; and cefepime, 6). All patients had renal failure; 1 also had hepatic failure. Patients presented with progressive disorientation or agitation, sometimes associated with mild facial or limb myoclonus, that had begun 1 to 10 days (mean, 5 +/- 2 days) after starting cephalosporin treatment. The EEG showed continuous or intermittent bursts of generalized, high-voltage, 1 to 2 Hz sharp wave activity or sharp and slow wave activity that resembled, but could be differentiated from, the triphasic waves seen in metabolic encephalopathies. Intravenous clonazepam suppressed the epileptiform activity completely in 5 patients and partially in the other 5. Cephalosporins were withdrawn, and antiepileptic therapy was started for all patients. All patients improved, 2 in less than 24 hours and the remainder within 2 to 7 days.. Cephalosporins can cause nonconvulsive status epilepticus in patients with renal failure. The clinical picture is difficult to differentiate from a that of metabolic encephalopathy unless an EEG is obtained. Physicians should be aware of this potentially dangerous complication.

Topics: Adult; Aged; Aged, 80 and over; Brain; Cefepime; Ceftazidime; Ceftriaxone; Cephalosporins; Electroencephalography; Female; Humans; Infusions, Intravenous; Male; Meningitis, Bacterial; Middle Aged; Osteomyelitis; Renal Insufficiency; Respiratory Tract Infections; Status Epilepticus

Topics: Aged; Blood-Brain Barrier; Cefepime; Cefotaxime; Cephalosporins; Cerebrospinal Fluid; Cerebrospinal Fluid Shunts; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; Hydrocephalus; Male; Meningitis, Bacterial; Meropenem; Postoperative Complications; Pseudomonas aeruginosa; Pseudomonas Infections; Thienamycins