chloramphenicol-succinate and Meningitis

Tularemia is a zoonotic disease caused by Francisella tularensis. Tularemia presents with various clinical illnesses, but meningitis is rare.. To describe a patient who developed typhoidal tularemia with atypical acute meningitis and to review the pathogenesis, clinical and laboratory features, and antibiotic drug treatment of reported cases of tularemic meningitis.. Case study and literature review.. University hospital, tertiary care center.. A 21-year-old healthy man who had recently worked as a professional landscaper in the Albuquerque, New Mexico, metropolitan area developed fever, malaise, headache, and a stiff neck.. Francisella tularensis cerebrospinal fluid culture, antibiotic sensitivity, transmission source, and outcome.. The cerebrospinal fluid contained a lymphocytic pleocytosis, negative Gram stain, and F tularensis isolation with chloramphenicol and streptomycin antibiotic sensitivities.. Although tularemia is uncommon and tularemic meningitis is rare in the United States, attention is drawn to the increasing number of cases in professional landscapers, the atypical cerebrospinal fluid picture, and unusual antibiotic sensitivities.

Topics: Administration, Oral; Adult; Chloramphenicol; Ciprofloxacin; Diagnosis, Differential; Drug Therapy, Combination; Francisella tularensis; Humans; Infusions, Intravenous; Male; Meningitis; New Mexico; Occupational Diseases; Streptomycin; Tularemia; United States

17 cases of purulent meningitis in 15 children, aged 1 day to 5 years (median 8 months) were treated with continuous i.v. infusion of chloramphenicol succinate. Free chloramphenicol in serum and cerebrospinal fluid (C.F.) was assayed by high performance liquid chromatography (HPLC). CF chloramphenicol levels averaged 45 +/- 14% of the serum level. Out of 16 patients only five received the usually recommended dosage. In three others because of initially or progressively high serum levels the dose had to be diminished. In eight others because of subtherapeutic levels the dose had to be raised. The highest dose (390 mg/kg body weight/d) was required in a 2 month old boy. He was shown to have a clearance rate for free chloramphenicol considerably higher than has been reported so far. Maturation of the metabolism could be observed in a small-for-date newborn who acquired a grey baby syndrome during the treatment of his first meningitis. Several weeks later he required exactly the recommended dose to reach therapeutic chloramphenicol levels. As a consequence of these observations we strongly recommend meticulous drug monitoring of chloramphenicol in order to meet the large biological variations seen particularly in neonates and young infants in their capacity to reach and maintain therapeutic serum levels.

Topics: Bacterial Infections; Child, Preschool; Chloramphenicol; Chromatography, High Pressure Liquid; Dose-Response Relationship, Drug; Female; Humans; Infant; Infant, Newborn; Kinetics; Male; Meningitis; Metabolic Clearance Rate

The absorption and disposition of orally administered chloramphenicol palmitate (chloramphenicol-P) was studied in seven neonates (four preterm, three term). The highest measured chloramphenicol serum concentrations occurred greater than or equal to 4 hours after the dose, and ranged from 5.5 to 23 micrograms/ml after doses of chloramphenicol-P 50 mg/kg/day orally. The dosage had to be increased in all preterm neonates from 25 mg/kg/day to 50 mg/kg/day to obtain adequate serum levels during therapy. In four neonates the apparent half-life could not be estimated, because there was no decline in serum concentrations. The apparent half-life was 3 and 6 hours, respectively, in two neonates in whom the serum concentration declined during the dosing interval. Urinary excretion of chloramphenicol and the glucoronide ester in three neonates varied from 24% to 55% of the total dose administered. These preliminary data suggest considerable variability in serum chloramphenicol levels when chloramphenicol-P is administered orally in neonates. The delay in achieving the maximum serum concentration, nondeclining serum curve, and low renal recovery is indicative of incomplete, prolonged, and erratic absorption, possibly related to delayed gastric emptying or decreased intraluminal hydrolysis of the palmitate ester.

Topics: Administration, Oral; Adsorption; Biological Availability; Chloramphenicol; Half-Life; Humans; Infant, Newborn; Infusions, Parenteral; Meningitis

Topics: Bacterial Infections; Chloramphenicol; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infusions, Parenteral; Meningitis

Regular drug monitoring during therapy with chloramphenicol sodium succinate is actually recommended by expert centers. In this report a case of meningitis due to Salmonella typhimurium is described, which underlines the necessity of examining both the chloramphenicol and the chloramphenicol succinate concentrations. It is suggested that medical microbiologists and clinicians should be encouraged to take advantage of new, quick, and sensitive methods for drug monitoring in order to achieve optimal therapy.

Topics: Chloramphenicol; Chromatography, High Pressure Liquid; Humans; Infant; Kinetics; Male; Meningitis; Salmonella Infections; Salmonella typhimurium

Topics: Adolescent; Child; Chloramphenicol; Geriatrics; Humans; Meningitis; Meningitis, Meningococcal; Meningitis, Pneumococcal; Staphylococcal Infections; Streptococcal Infections

Topics: Child; Chloramphenicol; Drug Therapy; Humans; Infant; Infant, Newborn; Meningitis; Meningitis, Bacterial