rifampin and Meningitis

Pediatric neurobrucellosis represents a common anthropozoonosis in endemic areas but only anecdotal reports are available till date. Using appropriate search terms in the database platforms of MEDLINE, SCOPUS and Web of Sciences, we performed a systematic review of all the cases of pediatric neurobrucellosis published in the medical literature till date, in the light of a case report. The protocol was registered under PROSPERO (CRD42022333907). Our search strategy yielded 187 citations of which 51 citations were included. A total of 119 cases were reviewed. Of these cases, eight of them had insufficient data. The most common presentation was meningitis with or without encephalitis (n = 79, 71.2%). A high prevalence of cranial neuropathies (n = 22, 20.7%) was observed in the pediatric population in which abducens palsy was the most common (n = 9, 8.1%). Diagnosis was based on multimodal investigations including standard agglutination test (n = 44, 39.6%), Rose Bengal test (n = 37, 33.3%), blood culture (n = 23, 20.7%), serology (n = 20, 18.0%) and cerebrospinal fluid (CSF) culture (n = 11, 9.9%). Rifampicin-based triple drug regimen was the most commonly employed (83/102, 81.4%). Pediatric neurobrucellosis was associated with greater frequency of sequalae (5.4%), deafness (2.7%) and mortality (2.7%), when compared to that of general population. Neurobrucellosis mimics neuro-tuberculosis in various aspects. The review highlights several unique aspects of this entity in children. A high index of suspicion can ensure prompt diagnosis, timely initiation of management and favorable outcomes.. Pediatric neurobrucellosis represents a common zoonosis in endemic areas but only anecdotal reports are available till date. Using appropriate search terms in the database platforms of MEDLINE, SCOPUS and Web of Sciences, we performed a systematic review of all the cases of pediatric neurobrucellosis published in the medical literature till date, in the light of a case report. Our search strategy yielded 187 citations of which 51 citations were included. A total of 119 cases were reviewed. When compared to the largest series in neurobrucellosis, a higher frequency of meningitis was observed in the pediatric age group (71.2% vs. 37%). A high prevalence of cranial neuropathies (n = 22, 20.7%) was observed in the pediatric population in which abducens palsy was the most common (n = 9, 8.1%). Diagnosis was based on multimodal investigations including standard agglutination test (n = 44, 39.6%), Rose Bengal test (n = 37, 33.3%), blood culture (n = 23, 20.7%), serology (n = 20, 18.0%) and CSF culture (n = 11, 9.9%). Rifampicin-based triple drug regimen was the most commonly employed (83/102, 81.4%). Our systematic review highlighted the wide and heterogeneous spectrum of manifestations of neurobrucellosis in the pediatric population. A high index of suspicion can ensure prompt diagnosis, timely initiation of management and favorable outcomes.

Topics: Brucellosis; Child; Humans; Meningitis; Rifampin; Tuberculosis

Besides its well known antibiotic activity rifampicin exerts multiple brain protective functions in acute cerebral ischemia and chronic neurodegeneration. The present mini-review gives an update of the unique activity of rifampicin in different diseases including Parkinson's disease, meningitis, stroke, Alzheimer's disease and optic nerve injury.

Topics: Alzheimer Disease; Animals; Antibiotics, Antitubercular; Brain; Humans; Meningitis; Neuroprotective Agents; Optic Nerve Injuries; Parkinson Disease; Receptors, Glucocorticoid; Rifampin; Stroke

Diffuse pachymeningitis is an uncommon presentation of tuberculous meningitis (TBM). We present a 78-year-old woman patient with a 1-year history of progressive headache and MRI of the brain compatible with diffuse pachymeningitis. Without strong evidence to support a diagnosis, she subsequently underwent dural biopsy which revealed caseous granulomatous inflammation and was positive for Mycobacterium tuberculosis complex by PCR. The dura tissue culture subsequently confirmed the diagnosis of TBM. Successful treatment with antituberculous drugs and corticosteroid was observed without complications. Literature review on characteristics, diagnoses and treatment of central nervous system tuberculosis was also performed.

Topics: Adrenal Cortex Hormones; Aged; Antibiotics, Antitubercular; Antitubercular Agents; Ethambutol; Female; Humans; Isoniazid; Meningitis; Mycobacterium tuberculosis; Prednisone; Pyrazinamide; Rifampin; Tuberculosis, Meningeal

This case report demonstrates an unusual complication after anterior decompression and fusion of a lumbar burst fracture.. The treatment of this patient involved placement of a computed tomography-guided percutaneous drain and intravenous antibiotics to treat an infected retroperitoneal pseudomeningocele.. A case of an anterior retroperitoneal pseudomeningocele complicated by meningitis is presented. This pseudomeningocele occurred in a patient after an L3 burst fracture associated with a dural laceration.. The patient was admitted to the authors' trauma unit after a motor vehicle accident with an acute L3 fracture associated with incomplete paraplegia. He underwent an urgent anterior corpectomy, strut grafting, and instrumentation. At surgery, he was noted to have a large anterior dural laceration. After surgery, a large retroperitoneal pseudomeningocele developed that became infected with Staphylococcus epidermidis.. After placement of a computed tomography-guided percutaneous drain and intravenous antibiotics, the pseudomeningocele resolved. His anterior fusion healed uneventfully and his neurologic deficit improved dramatically.. A case of an anterior retroperitoneal pseudomeningocele complicated by meningitis is presented. This pseudomeningocele occurred in a patient after an L3 burst fracture associated with a dural laceration. The patient was treated successfully with computed tomography-guided percutaneous drain placement and intravenous antibiotics. He made an excellent functional recovery after a severe neurologic injury.

Topics: Adolescent; Drainage; Drug Therapy, Combination; Humans; Lumbar Vertebrae; Male; Meningitis; Meningocele; Retroperitoneal Space; Rifampin; Spinal Fractures; Staphylococcal Infections; Staphylococcus epidermidis; Tomography, X-Ray Computed; Vancomycin

Topics: Amikacin; Anti-Bacterial Agents; Bacterial Infections; Cerebrospinal Fluid Shunts; Drug Resistance, Microbial; Drug Therapy, Combination; Escherichia coli Infections; Gentamicins; Humans; Injections, Intravenous; Injections, Intraventricular; Klebsiella Infections; Leukocytes; Meningitis; Premedication; Pseudomonas Infections; Reoperation; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Tobramycin; Vancomycin

Topics: Bacteria; Bacterial Infections; Humans; Kinetics; Meningitis; Rifampin

There is an ever-expanding number of antimicrobial agents available for the clinician to use to combat infections. We review the majority of such agents that are currently available relative to their theoretical or proven efficacy in the treatment of CNS infections. Due to the unique ability of the CNS to exclude many agents delivered via the blood stream, easily administered and efficacious therapy remains a problem. Based on the pharmacokinetics of anti-infective drugs and their antimicrobial spectrum, at present a penicillin derivative or chloramphenicol should be used whenever possible because parenteral therapy will usually achieve the desired results. In many neurosurgery-associated infections, intrathecal or intraventricular antibiotics may be required to supplement parenteral treatment and/or surgical intervention. Some of the more promising agents (such as rifampin, trimethoprim-sulfamethoxazole, and metronidazole) await further clinical trials to establish their place in the therapeutic armamentarium. Careful, randomized, prospective studies of prophylactic antibiotics must be performed in the neurosurgical setting. A group of tables are included that summarize the expected spinal fluid levels, the sensitivities of organisms commonly causing neurosurgical infections, doses of drugs given intrathecally or intraventricularly, and recommended regimens for certain infections.

Topics: Abscess; Anti-Bacterial Agents; Anti-Infective Agents; Central Nervous System Diseases; Cephalosporins; Cephamycins; Chloramphenicol; Erythromycin; Humans; Infections; Lincomycin; Meningitis; Metronidazole; Penicillins; Polymyxins; Rifampin; Sulfonamides; Tetracyclines; Trimethoprim; Vancomycin

Topics: Ampicillin; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meningitis; Rifampin; Streptococcal Infections; Streptococcus agalactiae

Topics: Ampicillin; Bacterial Infections; Brain Edema; Child, Preschool; Chloramphenicol; Cloxacillin; Gentamicins; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Injections, Spinal; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Methicillin; Minocycline; Neisseria meningitidis; Penicillin G; Rifampin; Seizures; Shock; Streptococcus pneumoniae; Sulfonamides

Topics: Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Bacitracin; Carbenicillin; Cephalosporins; Child; Child, Preschool; Chloramphenicol; Clindamycin; Erythromycin; Female; Humans; Infant; Infant, Newborn; Lincomycin; Male; Meningitis; Nalidixic Acid; Nitrofurans; Penicillin G; Polymyxins; Rifampin; Sepsis; Sulfonamides; Tetracycline; Trimethoprim

Topics: Amphotericin B; Animals; Bicarbonates; Dose-Response Relationship, Drug; Drug Therapy, Combination; Humans; Infusions, Parenteral; Injections, Intra-Articular; Injections, Intravenous; Injections, Spinal; Kidney; Mannitol; Meningitis; Mycoses; Rifampin

Topics: Anti-Bacterial Agents; Antitubercular Agents; Cephalosporins; Endocarditis, Bacterial; Enteritis; Gentamicins; Humans; Infections; Lincomycin; Meningitis; Penicillins; Rifampin; Sepsis; Staphylococcal Infections; Streptococcal Infections; Sulfonamides; Urinary Tract Infections; Vancomycin

Topics: Antitubercular Agents; Brain Mapping; Choroiditis; Confusion; Female; Humans; Isoniazid; Magnetic Resonance Imaging; Meningitis; Middle Aged; Optic Nerve Diseases; Pyrazinamide; Rifampin; Tuberculosis, Central Nervous System; Vision Disorders

A 9-year-old HIV-infected child previously treated with inadequate doses of antitubercular drugs based on weight was admitted 5 months after initial tuberculosis (TB) diagnosis with acute hemiplegia and inguinal lymphadenopathies in a rural hospital in Tanzania. He was diagnosed with TB meningitis and lymphadenitis using Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay. Rifampicin resistance was detected in the lymph node aspirate but not in the cerebrospinal fluid. His TB therapy was optimised based on available medications and antiretroviral treatment was initiated 6 weeks later. Despite these efforts, the clinical evolution was poor and the child died 12 weeks after admission.

Topics: Anti-HIV Agents; Antibiotics, Antitubercular; Child; DNA, Bacterial; Drug Resistance, Bacterial; Fatal Outcome; Hemiplegia; HIV Infections; Humans; Lymph Nodes; Lymphadenitis; Male; Meningitis; Mycobacterium tuberculosis; Rifampin; Tuberculosis, Multidrug-Resistant

No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ± 2.47 months in P1, 6.52 ± 4.15 months in P2, and 5.18 ± 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/117) and P3 (6.1%, n = 3/49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.

Topics: Administration, Oral; Adolescent; Adult; Aged; Anti-Bacterial Agents; Brucella; Brucellosis; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Male; Meningitis; Meningoencephalitis; Middle Aged; Recurrence; Retrospective Studies; Rifampin; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

Neurobrucellosis is an uncommon complication of pediatric brucellosis. Acute meningitis and encephalitis are the most common clinical manifestations, however symptoms may be protean and diagnosis requires a high index of suspicion in patients from endemic areas. Diagnosis is often based on neurological symptoms, serology, and suggestive brain imaging because cerebrospinal fluid culture yields are low. Two cases of pediatric neurobrucellosis with unusual clinical and radiologic findings are presented.

Topics: Adolescent; Anti-Bacterial Agents; Brucellosis; Child; Doxycycline; Drug Therapy, Combination; Encephalitis; Female; Gentamicins; Humans; Incidence; Israel; Meningitis; Neuroimaging; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Bacteremia; Blood; Cerebrospinal Fluid; Female; Flavobacteriaceae; Flavobacteriaceae Infections; Humans; Meningitis; Microscopy; Middle Aged; Rifampin; Stem Cell Transplantation; Transplantation; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Eosinophilic meningitis has been defined as meningitis in which a total cerebrospinal fluid (CSF) sample is found to have more than 10 eosinophils per millimeter or is composed of greater than 10% eosinophils. The differential diagnosis is broad and the clinical presentation, lacking an internalized CSF diversion system, is often nonspecific. With respect to patients with shunt systems, a positive correlation exists between CSF eosinophilia and eventual shunt failure requiring revision. In this paper the authors present the highest reported level of CSF eosinophilia in conjunction with a rifampin and minocycline-impregnated ventriculostomy catheter recently approved by the Food and Drug Administration.

Topics: Adolescent; Anti-Bacterial Agents; Antibiotics, Antitubercular; Catheterization; Diagnosis, Differential; Eosinophilia; Humans; Male; Meningitis; Minocycline; Rifampin; Ventriculostomy

Two hundred forty-five H. influenzae isolates responsible for meningitis in Poland from 1997 to 2004 were studied. Among these, 233 (95.1%) belonged to serotype b (Hib), 2 belonged to serotype f, and 10 were noncapsulated. The relatedness of all isolates was evaluated by pulsed-field gel electrophoresis (PFGE), and selected representatives were evaluated by multilocus sequence typing. Resistance to ampicillin was identified in 34 (14.6%) of the Hib isolates and was associated with the production of beta-lactamase only. Except for four isolates nonsusceptible to chloramphenicol, all isolates were susceptible to cefotaxime, ciprofloxacin, and rifampin. The PFGE analysis divided the Hib isolates into five PFGE types; however, all of them were possibly related. The most common PFGE type, with 25 subtypes, was characteristic for 97.4% of the isolates. The most prevalent PFGE subtype found in our study was also the most common among the Hib isolates responsible for invasive disease in Italy and the Czech Republic and was found among isolates causing lower respiratory tract infections in Poland. The most prevalent sequence types (STs) in the studied group were ST6 and ST92. Four new STs were found: ST188, ST189, ST190, and ST268. Results of this study support the evidence that the genetic structure of encapsulated H. influenzae is clonal. The continuing high number of meningitis cases due to Hib in Poland underlines the need for mass vaccination against Hib in Poland.

Topics: Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; beta-Lactamases; Cefotaxime; Ciprofloxacin; Electrophoresis, Gel, Pulsed-Field; Enzyme Inhibitors; Haemophilus influenzae type b; Humans; Meningitis; Microbial Sensitivity Tests; Poland; Rifampin

Acute amebic meningoencephalitis caused by free-living amebae naegleria fowleri is extremely rare and uniformly fatal with only seven survivals reported till date. An interesting case of naegleria meningitis diagnosed by wet mount cytology of cerebrospinal fluid (CSF) and treated with amphoterecin B, rifampicin and ornidazole with complete recovery is presented. In cases of suspected pyogenic meningitis, if CSF staining, antigen detection or culture is negative for bacteria, a wet mount cytology of CSF for naegleria is suggested. Early treatment with amphoterecin B and rifampicin may improve survival.

Topics: Adult; Amebiasis; Amebicides; Amphotericin B; Animals; Antiprotozoal Agents; Drug Therapy, Combination; Female; Humans; Meningitis; Naegleria fowleri; Ornidazole; Rifampin

Acanthamoeba was implicated as the causative agent of chronic meningitis in three apparently immunocompetent children. Diagnosis was established by cerebrospinal fluid wet mount examination and culture. Two children improved rapidly with combination oral therapy composed of trimethoprim-sulfamethoxazole, rifampin and ketoconazole.

Topics: Acanthamoeba; Administration, Oral; Amebiasis; Animals; Anti-Infective Agents; Antifungal Agents; Child; Child, Preschool; Chronic Disease; Drug Therapy, Combination; Enzyme Inhibitors; Female; Humans; Ketoconazole; Magnetic Resonance Imaging; Male; Meningitis; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of restricted meningeal infection by atypical mycobacteria, identified by the polymerase chain reaction, in a non-immunocompromised adult successfully treated by multiple antibiotics including fluoroquinolone. New quinolones should be considered as a therapeutic option for such mycobacterial meningitis.

Topics: Administration, Oral; Adult; Amikacin; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotics, Antitubercular; Antitubercular Agents; Cycloserine; Ethambutol; Humans; Injections, Spinal; Isoniazid; Male; Meningitis; Mycobacterium avium Complex; Mycobacterium Infections, Nontuberculous; Ofloxacin; Polymerase Chain Reaction; Rifampin; Streptomycin

The author presents 17 patients with tick-born neuroinfections. The correct diagnosis was established during serological examinations.

Topics: Adolescent; Adult; Animals; Child; Dexamethasone; Female; Hospitalization; Humans; Incidence; Male; Meningitis; Poland; Rifampin; Ticks; Treatment Outcome

The penetration of rifampicin into CSF was studied in seven patients who had undergone external ventriculostomy for occlusive hydrocephalus without major disturbance of the blood-CSF barrier. After the first dose of rifampicin 600 mg i.v. over 3 h, blood and CSF concentrations were determined serially by HPLC. Peak CSF concentrations obtained 0-8 h (median = 1 h) after the end of the infusion ranged from 0.57 to 1.24 mg/L (median = 0.73 mg/L). Elimination from CSF was slower than from serum (T1/2 beta CSF: 9.1-21.0 h (median = 14.5 h, n = 5); T1/2 beta serum: 2.2-5.8 h (median = 3.6 h, n = 7)). Based on the ratios of the areas under the concentration-time curves in CSF and serum, the overall penetration of rifampicin into CSF was 0.13-0.42 (median = 0.22). These results demonstrate effective CSF penetration and favourable pharmacokinetics of rifampicin in the absence of meningeal inflammation. They support the use of rifampicin as part of a combination therapy not only for tuberculosis of the central nervous system (CNS), but also for staphylococcal and listerial infections of the CNS in which there may be little meningeal inflammation.

Topics: Aged; Chromatography, High Pressure Liquid; Female; Half-Life; Humans; Male; Meninges; Meningitis; Middle Aged; Rifampin

BALB/c mice inoculated nasally with Acanthamoeba culbertsoni, resulting in amebic encephalitis and death 3-7 days, were treated with rifampicin prophylactically (daily for 2 days with 75 and 100 mg/kg) and after infection (daily for 5 days with doses of 10-100 mg/kg). Prophylactic treatment resulted in full protection against infection, as assessed by absence of symptoms of central nervous system malfunction and negative brain culture 10 days after inoculation. Curative treatment was effective at the same doses; however, at doses of 10, 25, and 50 mg/kg, only two of six animals were free of symptoms and infection.

Topics: Acanthamoeba; Amebiasis; Animals; Disease Models, Animal; Female; Male; Meningitis; Mice; Mice, Inbred BALB C; Rifampin

Topics: Acquired Immunodeficiency Syndrome; Adult; Cryptococcosis; Drug Interactions; Fluconazole; Humans; Male; Meningitis; Rifampin

Topics: Child; Child, Preschool; Chloramphenicol; Humans; Meningitis; Rifampin; Vanuatu

Infection with Brucella melitensis is endemic in Saudi Arabia but involvement of the central nervous system (CNS) is rare. We report on three patients with acute brucella meningitis, all of whom had a history of exposure to a possible source of infection. Diagnosis was confirmed by isolation of Brucella species from blood cultures. Examination of cerebrospinal fluid revealed lymphocytic pleocytosis with a high concentration of protein and low concentration of glucose. The patients were treated by combinations of co-trimoxazole, doxycycline or rifampicin. All responded well without recurrences. A combination of two of the three drugs was effective in treating brucellosis of the CNS when given for a period of 6-8 weeks.

Topics: Adult; Brucellosis; Doxycycline; Drug Combinations; Female; Humans; Male; Meningitis; Middle Aged; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The pharmacokinetics and bacteriological efficacy of nafcillin (NFPC), vancomycin (VCM), amikacin (AMK) and rifampicin (RFP) alone and in VCM combinations were evaluated in the experimental rabbit meningitis caused by methicillin-susceptible Staphylococcus aureus (MSSA) or methicillin-resistant Staphylococcus aureus (MRSA). The mean concentrations of NFPC, VCM, AMK and RFP in cerebrospinal fluid (CSF) with MSSA meningitis exceeded the minimal bactericidal concentrations of MSSA during 8 hours therapy period. The mean CSF penetration rates of the 4 drugs during therapy were from 1% to 26% which are comparable to those observed in humans with meningitis. The median CSF bactericidal titers of RFP, VCM plus RFP, AMK, VCM plus AMK regimens were larger than 1:8 during therapy of MSSA meningitis study. In experimental MRSA meningitis, RFP and VCM plus RFP achieved titers greater than 1: 16 during therapy and at 24 hours. No statistically significant reduction in the CSF bacterial colony count was obtained with any of the antibiotic regimens in MSSA meningitis. By contrast, in 8 hours MRSA meningitis model, significant reductions in the number of MRSA were observed in animals treated for 8 hours with VCM plus RFP (P less than 0.01), RFP (P less than 0.05), and NFPC plus RFP (P less than 0.01).

Topics: Amikacin; Animals; Child; Drug Therapy, Combination; Humans; Kanamycin; Kinetics; Meningitis; Methicillin; Nafcillin; Penicillin Resistance; Rabbits; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

A retrospective analysis of 10 adult patients with community-acquired Staphylococcus aureus meningitis was performed in order to elucidate the characteristics and treatment of this lethal disease. In all patients, a focus of infection outside the central nervous system was apparent at presentation. A poor prognosis was associated with severe underlying disease, greater degree of hyponatremia at presentation, development of seizures, failure of nuchal rigidity to develop, persistent or recurrent bacteremia, and the presence of concurrent S. aureus bronchopneumonia. Degree of deterioration in mental status and cerebrospinal fluid pleocytosis, protein levels, and glucose levels did not appear to have any prognostic significance. Therapy with rifampin and a semisynthetic penicillin effected a cure in all six patients treated with this regimen. In contrast, three of four patients treated with other antibiotic combinations died. On the basis of this experience, it is concluded that further trials with rifampin in combination with another anti-staphylococcal antibiotic for the treatment of S. aureus meningitis are warranted.

Topics: Adult; Aged; Blood Glucose; Cerebrospinal Fluid Proteins; Female; Glucose; Humans; Hyponatremia; Leukocyte Count; Male; Meningitis; Middle Aged; Nafcillin; Oxacillin; Prognosis; Retrospective Studies; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Three children had staphylococcal infections of the CNS. In two cases the organisms were resistant to methicillin sodium. Each case was treated with a combination of vancomycin hydrochloride and rifampin; in one instance vancomycin alone had been unsuccessful. The addition of rifampin resulted in prompt clinical and bacteriologic resolution. Satisfactory levels of rifampin were achieved by administering the drug either orally or intravenously, and in one patient oral administration of rifampin produced assayed levels in subdural pus many times that required for minimal bactericidal activity. Combination therapy with vancomycin and rifampin is recommended for staphylococcal infections of the CNS.

Topics: Adolescent; Brain Diseases; Cellulitis; Central Nervous System Diseases; Drug Therapy, Combination; Empyema, Subdural; Female; Humans; Infant; Male; Meningitis; Orbital Diseases; Rifampin; Staphylococcal Infections; Vancomycin

Combination of rifampicin with trimethoprim, erythromycin, tetracycline or fusidic acid have some desirable features in the treatment of difficult infections. They are active against a very wide range of possible pathogens. Resistance to rifampicin is rare. Such combinations may be bactericidal and may be usefully synergistic. They may prevent or delay the emergence of bacterial resistant seen when some single agents are used. They can be used in patients with penicillin hypersensitivity. A series of life-threatening infections has been treated with rifampicin-containing combinations. The infections included endocarditis, meningitis, pneumonia, Legionnaire's disease, and head and neck sepsis. A major reason for the choice of drug was often penicillin hypersensitivity. A second reason was the presumption (mostly subsequently confirmed) that streptococci and/or staphylococci were implicated. The clinical outcome of these infections was generally satisfactory, with few side effects and little evidence of the emergence of antibiotic resistance.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Drug Therapy, Combination; Erythromycin; Female; Fusidic Acid; Humans; Infant; Legionnaires' Disease; Male; Meningitis; Middle Aged; Osteomyelitis; Rifampin; Sepsis; Skin Diseases, Infectious; Staphylococcal Infections; Tetracycline; Trimethoprim

Topics: Adolescent; Adult; Blood-Brain Barrier; Cerebrospinal Fluid Proteins; Child; Glucose; Humans; Leukocyte Count; Meningitis; Middle Aged; Neutrophils; Rifampin

A case of fatal meningitis and septicemia with group JK Corynebacterium species in a leukopenic patient is reported. The strain was susceptible to rifampicin and vancomycin only. The finding of diphtheroids in bacteriological samples from immunocompromised patients should not be ignored. The literature regarding meningitis caused by diphtheroid bacilli is reviewed.

Topics: Adult; Burkitt Lymphoma; Corynebacterium; Humans; Leukopenia; Male; Meningitis; Rifampin; Vancomycin

Topics: Bacterial Infections; Erythromycin; Female; Flavobacterium; Humans; Infant; Meningitis; Rifampin

A combined kinetic and clinical study showed that rifampicin displays good tissue diffusibility, though it may have a tendency to accumulate. A liquor transfer sufficient for the bacteria most commonly responsible for meningeal inflammation was observed; 15/18 cases of purulent bacterial meningitis treated were clinically cured without sequelae, while 1 displayed considerable improvement. Two patients died from unforseen, uncontrollable complications that were not related to administration of the drug.

Topics: Adolescent; Adult; Bacterial Infections; Child; Drug Evaluation; Female; Humans; Infusions, Parenteral; Kinetics; Male; Meningitis; Microbial Sensitivity Tests; Middle Aged; Rifampin; Tissue Distribution

Three patients with Staphylococcus epidermis meningitis associated with cerebrospinal fluid (CSF) shunt devices were treated with a combination of intravenous vancomycin and oral rifampin. Two of the isolates were methicillin-resistant. All patients had a favorable clinical response. Time-kill curves showed that the addition of rifampin to vancomycin resulted in enhanced bactericidal activity against all isolates when compared to either antibiotic alone. This finding suggests that the combination of oral rifampin and intravenous vancomycin may be useful in the treatment of methicillin-resistant and recalcitrant methicillin-sensitive S. epidermis meningitis associated with CSF shunts. In vitro susceptibility testing should be performed.

Topics: Aged; Cerebrospinal Fluid Shunts; Child, Preschool; Drug Therapy, Combination; Female; Humans; Infant; Male; Meningitis; Rifampin; Staphylococcal Infections; Vancomycin

Topics: Adult; Cryptococcus; Cryptococcus neoformans; Ethambutol; Female; Humans; Isoniazid; Meningitis; Mycobacterium tuberculosis; Rifampin

Intrathecal vancomycin and oral rifampin have been used together to successfully treat a patient with enterococcal meningitis who was allergic to penicillin and who had failed a course of treatment with chloramphenicol. This therapy was tolerated very well and represents an alternate mode of therapy which should be considered in penicillin allergic patients with enterococcal meningitis.

Topics: Administration, Oral; Chloramphenicol; Drug Hypersensitivity; Drug Therapy, Combination; Humans; Injections, Spinal; Male; Meningitis; Middle Aged; Penicillins; Rifampin; Streptococcal Infections; Vancomycin

Topics: Amphotericin B; Clotrimazole; Drug Therapy, Combination; Flucytosine; Humans; Kidney Diseases; Meningitis; Miconazole; Mycoses; Rifampin; Thrombophlebitis

All of 16 infants with neonatal meningitis treated during a 30-month period were found to have accompanying ventriculitis at the time of the initial ventricular puncture. Fifteen of these infants were caused by gramm-negative organisms. All infants received antibiotics systemically and intraventricularly via an implanted ventriculostomy reservoir or by direct ventricular injection. Antibiotic concentrations within the ventricular fluid were monitored during chemotherapy; the complications encountered during treatment are discussed. Fifteen infants survived the infection; of these, seven infants were normal at follow-up examinations. In our experience intraventricular chemotherapy as an adjunct to systemic administration of antibiotics has greatly reduced the mortality rate in neonatal meningitis.

Topics: Ampicillin; Anti-Bacterial Agents; Cerebral Ventricles; Enterobacteriaceae Infections; Female; Flavobacterium; Gentamicins; Humans; Infant, Newborn; Infant, Newborn, Diseases; Injections, Intramuscular; Injections, Intraventricular; Male; Meningitis; Rifampin

Topics: Adolescent; Adult; Child; Child, Preschool; Drug Resistance, Microbial; Humans; Infant; Infant, Newborn; Meningitis; Middle Aged; Neisseria meningitidis; Rifampin; Sulfadiazine

Topics: Adolescent; Adult; Aged; Drug Combinations; Drug Tolerance; Ethambutol; Female; Follow-Up Studies; Hepatitis A; Humans; Liver; Liver Function Tests; Male; Meningitis; Middle Aged; Pelvic Inflammatory Disease; Rifampin; Spondylitis; Sputum; Tuberculosis, Pulmonary

Topics: Adolescent; Adult; Antibodies, Bacterial; Child; Child, Preschool; Female; Humans; Immunoglobulin M; Immunologic Deficiency Syndromes; Infant; Male; Meningitis; Meningococcal Infections; Rifampin; Sulfadiazine

Topics: Blood-Brain Barrier; Child; Child, Preschool; Female; Humans; Infant; Male; Meningitis; Meningoencephalitis; Rifampin