cefotaxime and Meningitis--Viral

Topics: Anti-Bacterial Agents; Cefotaxime; Coinfection; Disease Outbreaks; Disease Susceptibility; Drug Therapy, Combination; Enterovirus Infections; Female; Humans; Infant; Magnetic Resonance Imaging; Meningitis, Pneumococcal; Meningitis, Viral; Seasons; Vancomycin

Febrile infants under 3 months of age are often treated with broad-spectrum intravenous antibiotics while awaiting culture results, to prevent mother-to-child bacterial infections. Human parechoviruses (HPeV) have recently been described as etiologic agents of meningitis and severe sepsis in neonates and young infants. They are rarely investigated and are therefore probably underestimated. They cause acute clinical symptoms that can incorrectly suggest a bacterial infection. In the present case, a 6-week-old infant infected with HPeV developed severe sepsis, complicated by hepatic cytolysis, meningitis, acute renal failure, and mild hemophagocytic lymphohistiocytosis. HPeV type 3 was found by routine specific RT-PCR in cerebrospinal fluid, stools, and plasma. The outcome was spontaneously favorable after 4 days. Early diagnosis of the HPeV infection by routine specific RT-PCR reduces unnecessary antibiotic use and extended hospitalization in febrile young infants.

Topics: Acute Kidney Injury; Anti-Bacterial Agents; Cefotaxime; Citrobacter freundii; Drug Therapy, Combination; Early Diagnosis; Enterobacteriaceae Infections; Gentamicins; Humans; Infant; Male; Meningitis, Viral; Parechovirus; Picornaviridae Infections; Reverse Transcriptase Polymerase Chain Reaction; Risk Factors; Severity of Illness Index; Treatment Outcome; Viremia

After the cytology and the chemistry of the CSF had returned to normal, the concentration of ceftizoxime was determined in the CSF and in the serum of 27 patients who had suffered from purulent or serous meningitis. The patients were divided into four groups. The concentration in the CSF was mean = 0.87 mg/l two hours after a bolus injection of 2 g ceftizoxime. After an infusion of 2 g ceftizoxime over 30 minutes, the concentration in the CSF was mean = 0.32 mg/l one hour and mean = 0.99 mg/l two hours after the infusion was started. The highest concentrations in the CSF were obtained six hours after a bolus injection of 2 g ceftizoxime. The peak value was 4.3 mg/l and the mean 1.78 mg/l. Based on these pharmacokinetic data, additional injections could have a cumulative effect on the concentration of ceftizoxime in the CSF. With the exception of Staphylococcus sp., Pseudomonas sp. and some anaerobes, it can be expected that ceftizoxime will be effective against other organisms causing meningitis. The results of clinical applications remain to be seen.

Topics: Cefotaxime; Ceftizoxime; Humans; Kinetics; Meningitis; Meningitis, Viral