ro13-9904 and Meningitis--Bacterial

Acute bacterial meningitis in adults is a rare but serious condition that carries a high rate of morbidity.. This review highlights pearls and pitfalls of acute bacterial meningitis in adults, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.. Meningitis encompasses a broad spectrum of disease involving inflammation of the meninges and subarachnoid space. It classically presents with fever, nuchal rigidity, and altered mental status, but this triad is not present in all cases. Up to 95% of patients will have at least two of the following four cardinal symptoms: fever, nuchal rigidity, altered mental status, and headache. The most common bacterial etiologies are S. pneumoniae and N. meningitidis. Cerebrospinal fluid testing obtained by lumbar puncture remains the gold standard in diagnosis. Head computed tomography prior to lumbar puncture may not be necessary in most patients. Empiric treatment consists of vancomycin, ceftriaxone, and dexamethasone. Elevated intracranial pressure should be managed using established neurocritical care strategies.. A better understanding of the pearls and pitfalls of acute bacterial meningitis can assist emergency clinicians in pursuing its timely diagnosis and management.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Headache; Humans; Meningitis, Bacterial; Muscle Rigidity; Prevalence; Spinal Puncture; Streptococcus pneumoniae

Invasive infections caused by Capnocytophaga canimorsus are rare. Immunocompromised patients, who report being bitten by or having a close contact with an animal, represent a high-risk group for this infection. There are only few dozens of infections by this bacteria manifesting as purulent meningitis reported worldwide. The reported case is a first reported case of purulent meningitis caused by by Capnocytophaga canimorsus in Czech Republic with only a limited risk factor history.. The patient, a 74 years old man, was referred to the infectious diseases department of a teaching hospital with clear signs of developing purulent meningitis. His anamnestic data did not show any unusual findings. He was treated for compensated diabetes mellitus type II. The blood cultures were negative and the etiological agent did not grow from the cerebrospinal fluid (CSF) on common media. Eventually, it was identified by detecting pan-bacterial DNA and DNA sequencing. Subsequently, the pathogen was confirmed by anaerobic cultivation from CSF. Only after then the patient recalled being bitten by his German shepherd puppy during play. The patient was successfully treated intravenously by ceftriaxone.. Purulent meningitis caused by Capnocytophaga spp. is a rare disease, but it needs to be considered in patients at risk with pre-existing conditions, who report close contact with or being bitten by an animal. It is important to test for this microbe in cases with negative microbiological results for the more common agents.

Topics: Aged; Animals; Bites and Stings; Blood Culture; Capnocytophaga; Ceftriaxone; Czech Republic; Dogs; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Male; Meningitis, Bacterial

A 39-year-old previously healthy man was referred to our hospital because of acute onset of fever and consciousness disturbance. Neurological examinations revealed deteriorated consciousness, nuchal rigidity and Kernig's sign. A lumbar puncture yielded clouded fluid with a WBC 1,012/μl (polynuclear cell 96%), 147.3 mg/dl of protein, 44 mg/dl of glucose and Gram positive cocci. At first, he was treated with ceftriaxon and ampicillin. At Day 2, meropenem was added. Streptococcus agalactiae was isolated from blood and cerebrospinal fluid. He responded promptly to antimicrobial therapy, and within 2 days, he became lucid and afebrile. S. agalactiae was sensitive to ceftriaxone, ampicillin and meropenem. After Day 3, he was treated with meropenem only. We diagnosed his condition as S. agalactiae meningitis and was discharged from our hospital at Day 18. Many cases of S. agalactiae meningitis are known to occur in neonates, pregnant women, elderly, and persons with underlying disease such as diabetes, malignant disorders, liver dysfunction. But cases occurring in a previously healthy adult are rare. Neurologists should be aware that S. agalactiae may be cause bacterial meningitis in a previously healthy adults.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Consciousness Disorders; Drug Therapy, Combination; Fever; Humans; Immunocompetence; Male; Meningitis, Bacterial; Meropenem; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome

To describe an unusual clinical presentation of puerperal meningitis by Streptococcus agalactiae (S. agalactiae).. We report a case of puerperal meningitis for S. agalactiae, a rare form of infection in a healthy puerperal and with an atypical presentation.. We deeply report the clinical case, the procedures performed to exclude other diseases and management differences. It is compared with meningitis cases reported in the literature, and as in these, we opt for and early diagnosis and a rapid onset of antibiotic treatment.. Meningitis caused by S. agalactiae is not a frequent complication in the postpartum period, that requires early diagnosis and treatment of which depends the patient's prognosis.

Topics: Adult; Amoxicillin; Ceftriaxone; Dexamethasone; Diagnosis, Differential; Early Diagnosis; Female; Humans; Meningitis, Bacterial; Pregnancy; Puerperal Disorders; Streptococcal Infections; Streptococcus agalactiae; Vancomycin

Viridans streptococcus, an indigenous bacterial species of the mouth and gastrointestinal tract, is thought to be a rare cause of bacterial meningitis. The type of streptococcus involved is important because each type causes a different kind of meningitis and is associated with a different outcome. A 39-year-old previously healthy man was admitted due to the onset of acute purulent meningitis. A cerebrospinal fluid culture grew Streptococcus sanguis (S. sanguis). Although the patient was asymptomatic for dental caries, odontogenic maxillary sinusitis was found to be the cause of the meningitis. Treatment with intravenous antibiotics was successful. Following a review of the pertinent literature, we discuss the characteristics of S. sanguis meningitis.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Dental Caries; Humans; Male; Maxillary Sinusitis; Meningitis, Bacterial; Streptococcal Infections; Streptococcus sanguis

Streptococcus equi subsp. zooepidemicus rarely causes meningitis in humans by contact with domestic animals or their unpasteurized products. In this paper we reviewed the literature pertaining to the epidemiological and clinical aspects relating to this infection on previously reported cases of human disease. Additionally, the case of a 51-year-old female who acquired meningitis with this organism after contact with a horse is described. This patient was successfully treated with ceftriaxone, yet penicillin remains the treatment of choice. This aetiological agent should be considered in the proper epidemiological context.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Female; Horses; Humans; Meningitis, Bacterial; Middle Aged; Streptococcal Infections; Streptococcus equi; Treatment Outcome; Zoonoses

Deafness is a common and often permanent neurological sequel of Streptococcus (S.) suis meningitis. Suppurative labyrinthitis, rather than direct auditory nerve infection, has been found to be the site responsible for deafness. Neuroimaging is important to localise the site involved in hearing loss and to assess the feasibility of a cochlear implantation. S. suis is very sensitive to penicillin. Although a relapse of S. suis meningitis is uncommon, it can occur despite an adequate duration of appropriate antibiotic therapy. We describe a patient with S. suis meningitis, who developed permanent deafness from haemorrhagic labyrinthitis, as shown on magnetic resonance imaging. She suffered a relapse despite a seven-week course of intravenous antibiotics. A review on six cases of relapse reported in the literature shows that relapses occurred despite two to four weeks of antibiotics being administered to the patients. The clinical implications and treatment of relapse are discussed.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Cochlea; Cochlear Implants; Female; Hearing Loss; Hemorrhage; Humans; Labyrinthitis; Magnetic Resonance Imaging; Meningitis, Bacterial; Recurrence; Streptococcal Infections; Streptococcus suis

To evaluate the effectiveness and safety of short-course antibiotic therapy for bacterial meningitis, by performing a meta-analysis of randomised controlled trials (RCT).. PubMed and the Cochrane Central Register of Controlled Trials were searched for RCT on patients of all ages with community-acquired acute bacterial meningitis that compared treatment with the same antibiotics, in the same daily dosage, administered for a short course (up to 7 days) versus a longer course (2 days or more than corresponding short course).. Five open-label RCT involving children (3 weeks to 16 years) were included. No difference was demonstrated between short-course (4-7 days) and long-course (7-14 days) treatment (intravenous ceftriaxone) regarding: end-of-therapy clinical success (five RCT, 383 patients, fixed effect model (FEM), odds ratio (OR) 1.24, 95% CI 0.73 to 2.11); long-term neurological complications (five RCT, 367 patients, FEM, OR 0.60, 95% CI 0.29 to 1.27); long-term hearing impairment (four RCT, 241 patients, FEM, OR 0.59, 95% CI 0.28 to 1.23); total adverse events (two RCT, 122 patients, FEM, OR 1.29, 95% CI 0.57 to 2.91); or secondary nosocomial infections (two RCT, 139 patients, random effects model, OR 0.45, 95% CI 0.05 to 3.71). The duration of hospitalisation was lower with short-course treatment (two RCT, 137 patients, FEM, weighted mean difference -2.17 days, 95% CI -3.85 to -0.50). The available data did not allow for analysis by causative organism.. This meta-analysis of the rather limited available relevant data could not show differences between short and long-course antibiotic treatment for bacterial meningitis in children. Further research on this issue is required.

Topics: Administration, Oral; Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Cross Infection; Hearing Loss; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Randomized Controlled Trials as Topic

We report a case of gonococcal meningitis diagnosed by DNA amplification. A 47-year old man presented with a 4-day history of asymmetric painful swelling of his ankles and wrists, and skin rash. He had sex with men only but was HIV negative. Headache and photophobia led to a cerebrospinal fluid (CSF) examination that revealed meningitis. Cultures were negative but we detected Neisseria gonorrhoeae in his urine and CSF using a GC/chlamydia DNA amplification assay. The patient was discharged without sequela after 14 days of intravenous ceftriaxone.

Topics: Adolescent; Adult; Ceftriaxone; Cerebrospinal Fluid; Child; DNA, Bacterial; Female; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Middle Aged; Neisseria gonorrhoeae; Polymerase Chain Reaction; Urine

In this article we review the available data concerning meningitis caused by Capnocytophaga canimorsus. The clinical presentation of this rare condition is described with the emphasis on associated conditions and management issues. Two additional cases, illustrating the difficulties in recognizing this rare disease, are presented. Reviewing a total of 28 reported cases, a preceding bite-incident by a cat or dog, or close contact with these animals, was described in the majority of cases (89%). Patients had a median age of 58 years; splenectomy and alcohol abuse were noted in, respectively, 18% and 25% of patients. Only in one case immune suppressive drug use was reported. The diagnosis C. canimorsus meningitis should be considered in healthy and immunocompromised adults, especially after splenectomy, who present with symptoms attributable to meningitis and a history of recent exposure to dogs or cats. The possibility of this condition has implications for both the diagnostic work-up and the treatment of the patient.

Topics: Alcohol-Related Disorders; Animals; Bites and Stings; Capnocytophaga; Cats; Ceftriaxone; Dexamethasone; Diagnosis, Differential; Dogs; Drug Therapy, Combination; Gram-Negative Bacterial Infections; Humans; Male; Meningitis, Bacterial; Middle Aged; Opportunistic Infections; Risk Factors; Splenectomy

We report what we believe to be the first two cases of acute interstitial nephritis associated with vancomycin and ceftriaxone therapy in adults. A 40-year-old man with a medical history of traumatic brain injury and tonic-clonic seizure disorder was admitted to the hospital with a seizure episode and temperature of 103 degrees F. He was administered ceftriaxone, vancomycin, and acyclovir for suspected bacterial and/or viral meningitis. On day 4, the patient was noted to have diffuse erythematous plaques on the neck, chest, arms, abdomen, and back, as well as an elevated serum creatinine level of 3.1 mg/dl (baseline 0.9 mg/dl) and an elevated eosinophil count (6%). Dermatology and renal consultations were obtained, and a diagnosis of suspected acute interstitial nephritis was made. After a 3-day course of antibiotic treatment (day 4 of hospitalization), all antibiotics were discontinued and topical triamcinolone 0.1% ointment and hydrocortisone 2.5% cream were begun for the rash. The patient was discharged 5 days later with improvement in the rash, serum creatinine level (1.0 mg/dl), and eosinophil count (0.9%). A 59-year-old woman with a medical history of diabetes mellitus was admitted to the hospital with a serum creatinine level of 3.7 mg/dl, eosinophil count of 8.4%, and fractional excretion of sodium of 2.94%. The patient had been receiving treatment with vancomycin and ceftriaxone for osteomyelitis for 28 days before this hospital admission. Her baseline serum creatinine level (before antibiotic therapy) was 1.0 mg/dl. Renal consultation was obtained, and a diagnosis of probable acute interstitial nephritis was made. Ceftriaxone and vancomycin were discontinued, and her serum creatinine level gradually decreased to 3.3 mg/dl and then further to 1.5 mg/dl over the next 3 months. Use of the Naranjo adverse drug reaction probability scale revealed that the adverse reaction was possible in the first case and probable in the second case. Health care professionals need to be cognizant that drug-induced acute interstitial nephritis can be associated with concomitant administration of ceftriaxone and vancomycin therapy. Early detection of this rare adverse reaction is paramount in order to prevent acute renal insufficiency.

Topics: Acute Disease; Acyclovir; Adult; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Male; Meningitis, Bacterial; Meningitis, Viral; Middle Aged; Nephritis, Interstitial; Vancomycin

Bacterial meningitis remains a dangerous disease with frequent complications despite specific antibiotic therapy and intensive medical supportive treatment. Principal symptoms are headaches, high fever, meningismus and confusion or drowsiness that usually develop within a few hours. The diagnosis is mainly based on the examination of the cerebrospinal fluid and detection of the pathogen in the liquor or blood. Implementation of an early, empirical antibiotic therapy is important for the prognosis; community-acquired meningitides in adults should be treated with ceftriaxone and ampicillin. For infections with meningococci, the public health authorities must be also informed and chemoprophylaxis with rifampicin, ciprofloxacin or ceftriaxone for close contacts should be carried out.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Ciprofloxacin; Community-Acquired Infections; Critical Care; Enzyme Inhibitors; Hospitalization; Humans; Meningitis, Bacterial; Neisseria meningitidis; Prognosis; Rifampin; Streptococcus pneumoniae; Tomography, X-Ray Computed

Topics: Anti-Bacterial Agents; Ceftriaxone; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Humans; Meningitis, Bacterial; Otitis; Pyelonephritis; Sexually Transmitted Diseases

Topics: Acute Disease; Adrenal Cortex Hormones; Adult; Ceftriaxone; Drug Therapy, Combination; Humans; Meningitis, Bacterial; Vancomycin

Group B Streptococcus (Streptococcus agalactiae) is a well-known cause of early and late onset infections in neonates and very young infants. Recently attention has focused on the changing spectrum of invasive Group B Streptococcus (GBS) disease, including children beyond early infancy and non-pregnant adults. There is very little information available on invasive GBS infection especially meningitis in pediatric population older than three months of age. We report a case of uncomplicated meningitis due to GBS in a previously healthy 5-year-old boy. The literature on infection especially meningitis caused by Group B Streptococcus beyond infancy is reviewed.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Humans; Male; Meningitis, Bacterial; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome

We report a case of Salmonella infantis meningitis in a patient infected with HIV who was successfully treated with 4 weeks of therapy and has had no relapses after 12 months of follow-up. Only 10 episodes of Salmonella species meningitis in patients infected with HIV are reported in the literature.

Topics: Adult; AIDS-Related Opportunistic Infections; Ceftriaxone; Cephalosporins; Follow-Up Studies; Humans; Male; Meningitis, Bacterial; Salmonella Infections

Pasteurella multocida meningitis is a rare clinical occurrence. We report a new case and review the 28 other cases described in the English literature. A history of recent animal contact remains strongly associated with P. multocida meningitis (noted in 89% of all cases), with licking of mucus surfaces or injured skin being most common. Bacteremia was present in 63% of all patients. Spread from an adjacent site of infection continues to be an important factor, with otitis media being documented or strongly suspected in 24% of all cases. The presenting signs and symptoms were characteristic of bacterial meningitis, with fever, headache, nucal rigidity and an altered level of consciousness being present in most patients. Cerebrospinal fluid analysis was typical for bacterial meningitis. Penicillin G or ampicillin was the most common definitive treatment; however, third-generation cephalosporins have been successful. The mean duration of treatment was 14 d. Neurologic complications were present in 17% of patients overall and mortality remains substantial at 25%. Although not statistically significant, there is a trend toward decreased neurologic complications and mortality during the last 11 y.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Female; Gentamicins; Humans; MEDLINE; Meningitis, Bacterial; Pasteurella Infections; Pasteurella multocida

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

Group A streptococcal (GAS) invasive disease has become increasingly common in recent years. However, acute bacterial meningitis caused by this pathogen is unusual. We report a case of GAS meningitis in a previously healthy 21/2-year-old child associated with a dramatically rapid course and fatal outcome. A literature review of previously reported cases is presented. This case serves as a reminder that GAS can cause severe meningitis in otherwise healthy hosts.

Topics: Adolescent; Adult; Causality; Ceftriaxone; Child; Child, Preschool; Drug Therapy, Combination; Fatal Outcome; Female; Humans; Infant; Male; Meningitis, Bacterial; Penicillins; Streptococcus pyogenes; Vancomycin

Iatrogenic meningitis following lumbar puncture is a rare event. We present a 52-y-old man who developed symptoms of meningitis within 12 h after spinal anaesthesia. Cerebrospinal fluid cultures grew Streptococcus salivarius partially resistant to penicillin and ceftriaxone. The patient was successfully treated with ceftriaxone and vancomycin and left the hospital with minor sequelae. A literature review of 60 cases revealed the median age of the patients to be 44 y. The median incubation period was 24 h. Most cases occurred after spinal anaesthesia (n = 27), myelography (n = 20) and diagnostic lumbar puncture (n = 5). Organisms were isolated in 52 cases, and streptococcal species were responsible for 33 (63%) of them. An upward trend in resistance of S. viridans isolates is cause for concern and may change empirical treatment strategies. Death was reported in 3 cases (5%) and was associated with Pseudomonas and staphylococcal isolates. The recognition of this entity and the importance of proper infection control measures are underlined.

Topics: Anesthesia, Spinal; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Drug Resistance, Multiple, Bacterial; Humans; Iatrogenic Disease; Male; Meningitis, Bacterial; Middle Aged; Spinal Puncture; Streptococcal Infections; Streptococcus; Vancomycin

Biliary pseudolithiasis has been reported in patients who received ceftriaxone therapy. In addition to biliary sludge formation occasional reports of ceftriaxone-induced nephrolithiasis have been published. In general, these adverse effects will develop after seven to ten days of treatment. We report on a seven-year-old boy with ceftriaxone-associated biliary pseudolithiasis and nephrolithiasis four days after initiation of treatment. Patients receiving a high dose of ceftriaxone and developing colicky abdominal pain should be considered for ultrasound and a change in antibiotic therapy if appropriate.

Topics: Bile Duct Diseases; Ceftriaxone; Cephalosporins; Child; Diagnosis, Differential; Humans; Kidney Calculi; Lithiasis; Male; Meningitis, Bacterial; Neisseria meningitidis

Stomatococcus mucilaginosus, a normal inhabitant of the human oral cavity and upper respiratory tract, can cause fatal sepsis and meningitis in neutropenic patients. We identified eight cases of bacteremia due to S. mucilaginosus in children with cancer, of whom five developed complications despite receiving appropriate antibiotics. At the time cultures were positive, seven patients had profound neutropenia (< 100 neutrophils and band forms/mm3) and four had mucositis; five had central venous catheters. In two cases, there was unequivocal evidence of catheter-related sepsis. Bacteremia was eradicated in all patients within 48 hours after initiation of antibiotics. Despite prompt instigation of effective antibiotic therapy, the complication rates in this series were high: septic shock (50%), pneumonia (50%), dermatologic manifestations (38%), altered neurological status (25%), meningitis (13%), and adult respiratory distress syndrome (13%). No fatalities were attributable to S. mucilaginosus infection. These cases illustrate the virulence of S. mucilaginosus organisms in neutropenic children and suggest a substantial risk of sequelae even when adequate antibiotic therapy is given.

Topics: Adolescent; Bacteremia; Ceftazidime; Ceftriaxone; Child; Child, Preschool; Female; Gram-Positive Bacterial Infections; Humans; Male; Meningitis, Bacterial; Micrococcaceae; Neoplasms; Neutropenia; Pneumonia; Respiratory Distress Syndrome; Shock, Septic; Skin Diseases; Vancomycin

Children with bacterial meningitis are ideal candidates for outpatient parenteral antibiotic therapy; most recover from the acute infection within five days and do not require skilled nursing observation of neurologic status during the entire course of therapy. Before discharge, the child should be afebrile, show a good response to therapy, and demonstrate no neurologic abnormalities.

Topics: Ambulatory Care; Ceftriaxone; Child; Humans; Infusions, Intravenous; Meningitis, Bacterial; Outpatients; Patient Discharge

Topics: Cefotaxime; Ceftriaxone; Chemotherapy, Adjuvant; Child; Dexamethasone; Drug Administration Schedule; Humans; Infant; Meningitis, Bacterial; Spinal Puncture

Bacterial meningitis remains one of the most common life threatening infections of childhood. There exists a conventional therapy for this disease. However, with the increasing incidence of Haemophilus strains resistant to ampicillin and chloramphenicol and Streptococcus pneumonia strains relatively resistant to penicillin, alteration of current therapeutic regimens for meningitis may become necessary. Cephalosporins were considered as alternatives to the conventional therapy for the treatment of bacterial meningitis during the past decade. However, there are still some discrepancies on the use of these against some organisms despite the advent of the cephalosporins. Thus, a review article analyzing quite a number of reliable clinical trials related to cephalosporins for the treatment of bacterial meningitis during the past decade to date is introduced.

Topics: Ampicillin; Ceftriaxone; Cefuroxime; Cephalosporins; Child; Child, Preschool; Drug Therapy, Combination; Humans; Meningitis, Bacterial; Meningitis, Haemophilus

The purpose of this prospective study was to document the efficacy of ceftriaxone in the treatment of childhood bacterial meningitis in a general paediatric unit.. All children presenting with bacterial meningitis to Christchurch Hospital between January 1987 and June 1991 were enrolled in this prospective study and received ceftriaxone 100 mg/kg/d for seven days. Outcome was defined by parameters including mean time to fever defervescence, prolonged fever, days in hospital, seizures, and other acute neurological sequelae, requirement for ventilation, mortality and morbidity. Audiology was performed at six weeks and again at three months if abnormal. Neurodevelopmental assessment was performed at three months. Side effects were recorded.. There were 62 evaluable children. The mortality rate was 4.8% (3 children). Two children (3.4%) had clinically detectable neurological sequelae at the three month assessment. The mean duration of stay was 8.7 nights. Five children (8%) required ventilation. Mild self limiting diarrhoea occurred in 29%.. Ceftriaxone is an effective, safe and well tolerated antimicrobial for the treatment of childhood meningitis. It compares favourably with other equipotent antimicrobials. With a relatively long half life once daily administration is possible with a cost advantage.

Topics: Amoxicillin; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Chloramphenicol; Clinical Trials as Topic; Female; Humans; Infant; Male; Meningitis, Bacterial; Prospective Studies; Treatment Outcome

Topics: Ceftriaxone; Follow-Up Studies; Humans; Meningitis, Bacterial

Bacterial meningitis is a serious infectious disease, the course of which depends on the correct use of antibiotics and an intensive symptomatic and support therapy. The presence of microbes and their fractions in the CNS determines inflammatory phenomena that lead, through complex mechanisms, to the supportive treatment has the purpose of curbing the inflammatory phenomena, reducing cerebral oedema and avoiding ischaemia. This therapy makes use of cortisone and mannitol. The effectiveness of cortisone in reducing cerebral damage and, consequently, the neurological sequelae of the disease has been documented in experimental models and in man. After analysing the pathogenetic events of cerebral damage and the rationale of the treatment, reference is made to a personal therapeutic protocol that includes an aetiological treatment (Ceftriaxone 100 mg/kg/die), a support therapy (dexamethasone 0.2-0.3 mg/kg/die, mannitol, water restriction) and a symptomatic therapy (for convulsions, high temperature and shock). Both the antibiotic and cortisone are also introduced into the spine on the occasion of lumbar injection. 122 children suffering from non-tubercular bacterial meningitis, admitted to the Emergency Department of the Regina Margherita Infant Hospital of Turin in the period 1984-89, were treated. A further 7 patients, admitted for the same pathology, died within a few hours. In 88% of cases, aetiological agents were found by bacterioscopic and/or cultural and/or co-agglutinin on liquor examination (Neisseria meningitidis 47.5%, Haemophilus influenzae 20.5%, Streptococcus pneumoniae 15.6%, others 4.1%). The patients were treated with support therapy for as long as clinical conditions required it and with Ceftriaxone until clinical cure, end of fever and normalisation of PRC. In the reported series, 90% of patients were treated for from 3 to 6 days. This duration of antibiotic therapy is shorter than that reported and recommended in the literature. Therapeutic results were very good with 95% cure without neurological sequelae even at 6 month/1 year follow-up. Only 6 patients reported sequelae (2 irritative anomalies at EEG, 3 hypoacusis, 12 psychomotor retardation). The results were also better than those reported in the Italian and foreign literature. The Authors are convinced that, in the hands of experienced physicians, timely antibiotic, anti-inflammatory, cerebral anti-oedema and symptomatic treatment will improve the prognosis for bacterial meningitis

Topics: Adolescent; Anti-Bacterial Agents; Brain; Ceftriaxone; Child; Child, Preschool; Cortisone; Dexamethasone; Electroencephalography; Humans; Infant; Infant, Newborn; Mannitol; Meningitis, Bacterial; Prognosis

High dosages of ceftriaxone are used to treat central nervous system (CNS) infections. Dosage adaptation according to the glomerular filtration rate is currently not recommended. Ceftriaxone pharmacokinetics (PK) was investigated by a population approach in patients enrolled in a French multicenter prospective cohort study who received high-dose ceftriaxone for CNS infection as recommended by French guidelines (75 to 100 mg/kg of body weight/day without an upper limit). Only those with suspected bacterial meningitis were included in the PK analysis. A population model was developed using Pmetrics. Based on this model, a dosing nomogram was developed, using the estimated glomerular filtration rate (eGFR) and total body weight as covariates to determine the optimal dosage allowing achievement of targeted plasma trough concentrations. Efficacy and toxicity endpoints were based on previous reports, as follows: total plasma ceftriaxone concentrations of ≥20 mg/liter in >90% of patients for efficacy and ≤100 mg/liter in >90% of patients for toxicity. Based on 153 included patients, a two-compartment model including eGFR and total body weight as covariates was developed. The median value of the unbound fraction was 7.57%, and the median value of the cerebral spinal fluid (CSF)/plasma ratio was 14.39%. A nomogram was developed according to a twice-daily regimen. High-dose ceftriaxone administration schemes, used to treat meningitis, should be adapted to the eGFR and weight, especially to avoid underdosing using current guidelines. (This study has been registered at ClinicalTrials.gov under identifier NCT01745679.).

Topics: Anti-Bacterial Agents; Body Weight; Ceftriaxone; Cohort Studies; Cross Infection; Drug Administration Schedule; Female; Glomerular Filtration Rate; Humans; Male; Meningitis, Bacterial; Middle Aged; Monte Carlo Method; Nomograms; Prospective Studies; Treatment Outcome

Treatment of acute bacterial meningitis in children with bactericidal antibiotics causes cell wall lysis and a surge in inflammatory cascade, which in turn contributes to neuronal damage and morbidity. Pretreatment with a nonbacteriolytic antibiotic, such as rifampin, has been shown to attenuate the inflammatory response in experimental models of bacterial meningitis. In a pilot study, in children with bacterial meningitis, we have studied markers of inflammatory response and neuronal damage in 2 groups of children with bacterial meningitis; one group received rifampin pretreatment with ceftriaxone and the other group received ceftriaxone alone.. Forty children with bacterial meningitis, who were 3 months to 12 years of age, were randomly assigned to receive either a single dose rifampin (20 mg/kg) 30 minutes before ceftriaxone or ceftriaxone alone was given. The primary outcome variables were cerebrospinal fluid (CSF) concentrations of tumor necrosis factor alpha (TNFα), S100B and neuron-specific enolase on day 1 and day 5, and secondary outcome variables were the values of TNFα and interleukin 6 in serum on day 1 and day 5; hearing and neurologic sequelae at 3 months after recovery from the illness.. Children in rifampin pretreatment group had significantly lower CSF TNFα concentrations [median (interquartile range [IQR]): 15.5 (7.2-22.0) vs. 53.0 (9.0-87.5) pg/mL, P = 0.019] and S100B [median (IQR): 145.0 (54.7-450.0) vs. 447.5 (221.0-804.6) pg/mL, P = 0.033] on day 1 and S100B [median (IQR): 109.7 (64.0-287.0) vs. 322 (106.7-578.0) pg/mL, P = 0.048] and neuron-specific enolase [median (IQR): 8.6 (5-14.75) vs. 18.2 (7.0-28.75) ng/mL, P = 0.035] on day 5 when compared with ceftriaxone alone group. The rifampin-treated group also had reduced morbidity and neurologic sequelae; however, these were not statistically significant.. Pretreatment with single dose rifampin 30 minutes before ceftriaxone administration reduced the CSF concentrations of markers of inflammation and neuronal damage in children with bacterial meningitis.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Cranial Nerve Diseases; Humans; Infant; Inflammation; Interleukin-6; Meningitis, Bacterial; Phosphopyruvate Hydratase; Pilot Projects; Rifampin; S100 Calcium Binding Protein beta Subunit; Treatment Outcome; Tumor Necrosis Factor-alpha

The World Health Organization recommends benzylpenicillin and gentamicin as antimicrobial treatment for infants with sepsis in low-income settings, and ceftriaxone or cefotaxime as an alternative. In a meta-analysis from 13 low-income settings, Staphylococcus aureus, Klebsiella spp. and Escherichia coli accounted for 55% of infants with sepsis. In a review of bacterial meningitis, resistance to third generation cephalosporins was >50% of all isolates, and 44% of Gram-negative isolates were gentamicin resistant. However, ceftriaxone may cause neonatal jaundice, and gentamicin may cause deafness. Therefore, we compared parenteral benzylpenicillin plus gentamicin with ceftriaxone as first-line treatment, assessing outcome and adverse events.. This was an open randomized trial carried out in the Queen Elizabeth Central Hospital, Blantyre, Malawi, from 2010 to 2013. Infants <60 days of age with possible severe sepsis received either benzylpenicillin and gentamicin or ceftriaxone. Adverse events and outcomes were recorded until 6 months post discharge.. Three-hundred forty-eight infants were included in analyses. Outcome in the benzylpenicillin and gentamicin and ceftriaxone groups was similar; deaths were 13.7% and 16.5% and sequelae were 14.5% and 11.2%, respectively. More infants in the penicillin/gentamicin group required phototherapy: 15% versus 5%, P = 0.03. Thirteen (6%) survivors had bilateral hearing loss. There was no difference between the treatment groups. By 6 months post discharge, 11 more infants had died, and 17 more children were found to have sequelae.. Ceftriaxone and gentamicin are safe for infants in our setting. Infants should receive long-term follow-up as many poor outcomes occurred after hospital discharge.

Topics: Anti-Bacterial Agents; Bilirubin; Ceftriaxone; Gentamicins; Hearing Loss; Humans; Infant; Infant, Newborn; Malawi; Meningitis, Bacterial; Neonatal Sepsis; Penicillin G; Treatment Outcome

We investigated the benefit of 2 candidate adjunctive therapies in bacterial meningitis: glycerol, which has shown promise in earlier studies, and acetaminophen, which is reportedly beneficial in adult septicemia. In a hospital in Blantyre, Malawi, we enrolled 360 children aged ≥ 2 months with proven bacterial meningitis (36% HIV infected) in a double-blind, randomized, placebo-controlled trial of glycerol and acetaminophen in a 2 × 2 factorial design. Of 4 groups, first group received oral glycerol, second received rectal acetaminophen, third received both therapies and the fourth received placebos only. Adjuvant therapies were given for the first 48 hours of antibiotic therapy. Endpoints were mortality and neurological sequelae. Baseline findings were similar across all groups, except that many children had prior antibiotics in the acetaminophen group and many were anemic in the acetaminophen and glycerol group. Outcomes were similar for all groups. We found no benefit from oral glycerol or rectal acetaminophen in, mostly pneumococcal, meningitis in Malawian children.

Topics: Acetaminophen; Anti-Bacterial Agents; Ceftriaxone; Double-Blind Method; Drug Therapy, Combination; Glycerol; Hearing Loss; Humans; Infant; Malawi; Meningitis, Bacterial; Treatment Outcome

Community-acquired bacterial meningitis (CABM) is a life-threatening condition that is common among immunocompromised individuals. Intravenous ceftriaxone, of which Rocephin (ROC) is the originator brand, is recommended as first-line therapy in South Africa. Despite concerns regarding therapeutic equivalence with generic agents, this is the first study that has been conducted comparing clinical pharmacokinetics (PK) of a generic ceftriaxone formulation with the originator.. To compare the PK and safety of Aspen Ceftriaxone (AC) and ROC in the treatment of adult CABM.Methods. A total of 63 eligible patients were randomised 1:1 to receive 2 g of either medication twice daily for a duration based on the identity of the causative organism and their physician's clinical judgment. The primary endpoint of this study was the comparison of clinical PK, specifically the concentrations of each drug in the cerebrospinal fluid with corresponding paired plasma samples. While this study was underpowered to assess efficacy, safety could be evaluated on the basis of reported adverse events.. The two patient groups were epidemiologically similar. There were no statistically significant differences in PK between either agent, nor any difference with regard to safety.. AC can be considered as equivalent to ROC with regard to PK and safety in patients with CABM.

Topics: Administration, Intravenous; Adult; Anti-Bacterial Agents; APACHE; Biological Availability; Ceftriaxone; Community-Acquired Infections; Dose-Response Relationship, Drug; Double-Blind Method; Drug Monitoring; Drugs, Generic; Female; Humans; Male; Meningitis, Bacterial; Middle Aged; Therapeutic Equivalency; Treatment Outcome

Bacterial meningitis is an important cause of morbidity and mortality in developing countries, but the duration of treatment is not well established. We aimed to compare the efficacy of 5 and 10 days of parenteral ceftriaxone for the treatment of bacterial meningitis in children.. We did a multicountry, double-blind, placebo-controlled, randomised equivalence study of 5 versus 10 days of treatment with ceftriaxone in children aged 2 months to 12 years with purulent meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae type B, or Neisseria meningitidis. Our study was done in ten paediatric referral hospitals in Bangladesh, Egypt, Malawi, Pakistan, and Vietnam. We randomly assigned children who were stable after 5 days of treatment, through site-balanced computer-generated allocation lists, to receive a further 5 days of ceftriaxone or placebo. Patients, their guardians, and staff were masked to study-group allocation. Our primary outcomes were bacteriological failure or relapse. Our analysis was per protocol. This study is registered with the International Standard Randomised Controlled Trial Number Register, number ISRCTN38717320.. We included 1004 of 1027 children randomly assigned to study groups in our analyses; 496 received treatment with ceftriaxone for 5 days, and 508 for 10 days. In the 5-day treatment group, two children (one infected with HIV) had a relapse; there were no relapses in the 10-day treatment group and there were no bacteriological failures in either study group. Side-effects of antibiotic treatment were minor and similar in both groups.. In children beyond the neonatal age-group with purulent meningitis caused by S pneumoniae, H influenzae type b, or N meningitidis who are stable by day 5 of ceftriaxone treatment, the antibiotic can be safely discontinued.. United States Agency for International Development.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Developing Countries; Double-Blind Method; Drug Administration Schedule; Female; Humans; Infant; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Pneumococcal; Neisseria meningitidis; Therapeutic Equivalency; Treatment Outcome

Several studies have evaluated dexamethasone for prevention of hearing loss in childhood bacterial meningitis, but results have varied. We compared dexamethasone and/or glycerol recipients with placebo recipients, and measured hearing at 3 threshold levels.. Children aged 2 months to 16 years with meningitis were treated with ceftriaxone but were double-blindly randomly assigned to receive adjuvant dexamethasone intravenously, glycerol orally, both agents, or neither agent. We used the Glasgow coma scale to grade the presenting status. The end points were the better ear's ability to detect sounds of >40 dB, >or=60 dB, and >or=80 dB, with these thresholds indicating any, moderate-to-severe, or severe impairment, respectively. All tests were interpreted by an external audiologist. Influence of covariates in the treatment groups was examined by binary logistic regression.. Of the 383 children, mostly with meningitis caused by Haemophilus influenzae type b or Streptococcus pneumoniae, 101 received dexamethasone, 95 received dexamethasone and glycerol, 92 received glycerol, and 95 received placebo. Only the presenting condition and young age predicted impairment independently through all threshold levels. Each lowering point in the Glasgow scale increased the risk by 15% to 21% (odds ratio: 1.20, 1.21, and 1.15 [95% confidence interval: 1.06-1.35, 1.07-1.37, and 1.01-1.31]; P = .005, .003, and .039) for any, moderate-to-severe, or severe impairment, respectively. Each increasing month of age decreased the risk by 2% to 6% (P = .0001, .0007, and .041, respectively). Neither dexamethasone nor glycerol prevented hearing loss at these levels regardless of the causative agent or timing of antimicrobial agent.. With bacterial meningitis, the child's presenting status and young age are the most important predictors of hearing impairment. Little relief is obtained from current adjuvant medications.

Topics: Administration, Oral; Adolescent; Audiometry; Ceftriaxone; Child; Child, Preschool; Confidence Intervals; Dexamethasone; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Glycerol; Hearing Loss; Humans; Infant; Infusions, Intravenous; Logistic Models; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Pneumococcal; Odds Ratio; Probability; Prospective Studies; Risk Assessment; Severity of Illness Index; Time Factors; Treatment Outcome

The clinical course and outcome of non-typhoidal salmonella (NTS) meningitis in Malawian children over a 10-year period (1997-2006) is described.. Demographic, clinical and laboratory data were collected for all children over 2 months of age admitted with salmonella meningitis to Queen Elizabeth Central Hospital from 1997 to 2006. In the 1st year, salmonellae were susceptible to chloramphenicol, and children received 2 weeks of chloramphenicol treatment. When NTS resistance to chloramphenicol started to appear in 1998, treatment was changed to ceftriaxone. From 2002, the duration of antibiotic therapy was extended to 4-weeks which included 2 weeks of intravenous ceftriaxone and a further 2 weeks of oral ciprofloxacin.. The in-hospital case fatality rate (CFR) was 52.3% (48.2% until 2002 and 53.9% after prolonged antibiotic therapy was introduced). Of the survivors, one in 12 (8.3%) became completely well (sequelae-free) in the period 1997-2001 while 18 of 31 survivors (58.1%) made a complete recovery during 2002-2006 (p<0.01). After the 4-week course of antimicrobial therapy was introduced, the number of relapses or recurrences fell from nine in 15 (60%) survivors treated with chloramphenicol or ceftriaxone to three in 35 (8.7%) survivors who received 4 weeks of antibiotics (p<0.0001).. In Malawi, salmonella meningitis has a CFR of approximately 50%, which has remained constant over many years. Residual morbidity, however, has decreased over 10 years, despite rising numbers of multi-drug-resistant cases of NTS. This improvement might be owing to better treatment and management and/or reduced pathogenicity of the multi-drug-resistant bacteria.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Ciprofloxacin; Double-Blind Method; Drug Resistance, Bacterial; Drug Therapy, Combination; Humans; Infant; Meningitis, Bacterial; Nutritional Status; Prognosis; Prospective Studies; Recurrence; Salmonella Infections; Treatment Outcome

Oral glycerol reduces severe neurologic sequelae in childhood bacterial meningitis, but the mechanism awaits elucidation. We conducted a prospective, randomized, double-blind study in which the effects of glycerol and intravenous dexamethasone were compared with placebo recipients in an intensive care setting in India.. Thirty-six children at age 2 months to 12 years with meningitis were treated with ceftriaxone and were randomized to receive also either dexamethasone intravenously, or glycerol orally, or both agents, or neither. The illness was monitored with preset criteria. The primary outcome measures were the changes in plasma osmolality and in urine output.. Nine children received glycerol, 8 dexamethasone, 11 both agents, and 8 only placebo. The leading agents identified were Streptococcus pneumoniae, Haemophilus influenzae type b, and Staphylococcus aureus. Only the glycerol recipients increased plasma osmolality by up to 3% from the mean baseline of 294 mOsm/kg in the glycerol and 295 mOsm/kg in the glycerol-dexamethasone group. This change occurred within 6 hours, the critical period of treatment, and lasted <24 hours. Blood pressure was not affected, nor did urine output increase. The dexamethasone-only and placebo-only recipients showed immediate decrease in serum osmolality.. Because excretion of the cerebrospinal fluid is inversely associated with plasma osmolality, we suggest that the glycerol-induced osmolality increase reduce the volume of cerebrospinal fluid, enhanced water movement back to the plasma by osmosis, increased cerebral blood flow, and thus, improved brain oxygenation.

Topics: Ceftriaxone; Cerebrovascular Circulation; Child; Child, Preschool; Dexamethasone; Double-Blind Method; Female; Glycerol; Humans; Infant; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Pneumococcal; Osmolar Concentration; Staphylococcal Infections

Shunt infection represents a particularly morbid condition, which can also result in mortality. In order to decrease the high morbidity and mortality rates, prevention is an essential step. The purpose of this study was to compare the prophylactic use of ceftriaxone and trimethoprim-sulfamethoxazole (SXT) for the prevention of ventriculoperitoneal (VP) shunt infection.. In this prospective, single-institution, randomized clinical trial, 107 children with hydrocephalus and an indication for shunting were randomly assigned to prophylaxis with ceftriaxone (n = 50) or SXT (55), each administered as a single dose during anesthesia and two divided doses postoperatively. Patients were followed up for at least one year.. The mean age of patients was 15 months, and 85% were aged 6 months or younger. During the first postoperative year, meningitis occurred in 13.5% of patients receiving ceftriaxone and 14.5% of the SXT group, with no statistically significant difference between the groups. Younger age, presence of cerebrospinal fluid leakage and aqueductal stenosis as a cause of hydrocephalus showed significant correlation with meningitis occurrence on univariate analysis. However, only the latter 2 factors were associated with meningitis on multivariate analysis. The risk of shunt infection did not correlate with the gender of the patient, time of VP shunt surgery, or duration of hospitalization for shunting.. Ceftriaxone and SXT showed similar efficacy in preventing shunt infection. Cerebrospinal fluid leakage before or after VP shunt placement and aqueductal stenosis were independent risk factors for meningitis after VP shunt.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Female; Humans; Infant; Male; Meningitis, Bacterial; Postoperative Complications; Surgical Wound Infection; Trimethoprim, Sulfamethoxazole Drug Combination; Ventriculoperitoneal Shunt

Despite favorable meta-analyses, no study involving third-generation cephalosporins for the treatment of childhood bacterial meningitis has documented a benefit of adjuvant dexamethasone therapy if the outcomes are examined individually.. We conducted a prospective, randomized, double-blind trial comparing adjuvant dexamethasone or glycerol with placebo in children aged from 2 months through 16 years in Latin America. Ceftriaxone was administered to all children; children were randomized to also receive dexamethasone intravenously, glycerol orally, both agents, or neither agent. Primary end points were death, severe neurological sequelae, or deafness, with the first 2 end points forming a composite end point. A subgroup analysis for Haemophilus influenzae type b meningitis was undertaken. Intention-to-treat analysis was performed using binary logistic regression models.. H. influenzae type b, pneumococci, and meningococci were the main agents found among 654 patients; dexamethasone was given to 166, dexamethasone and glycerol were given to 159, glycerol was given to 166, and placebo was given to 163. No adjuvant therapy significantly affected death or deafness. In contrast, glycerol and dexamethasone plus glycerol reduced severe neurological sequelae, compared with placebo; the odds ratios were 0.31 (95% confidence interval [95% CI], 0.13-0.76; P=.010) and 0.39 (95% CI, 0.17-0.93; P=.033), respectively. For neurological sequelae and death, the odds ratios were 0.44 (95% CI, 0.25-0.76; P=.003) and 0.55 (95% CI, 0.32-0.93; P=.027), respectively. Dexamethasone therapy prevented deafness in patients with H. influenzae type b meningitis only if patients were divided grossly into dexamethasone recipients and nonrecipients and if timing between dexamethasone and ceftriaxone administration was not taken into account (odds ratio, 0.27; 95% CI, 0.09-0.77; P=.014).. Oral glycerol therapy prevents severe neurological sequelae in patients with childhood meningitis. Safety, availability, low cost, and oral administration also add to its usefulness, especially in resource-limited settings.

Topics: Adolescent; Anti-Bacterial Agents; Anti-Inflammatory Agents; Ceftriaxone; Chemotherapy, Adjuvant; Child; Child, Preschool; Deafness; Death; Dexamethasone; Double-Blind Method; Drug Therapy, Combination; Female; Glycerol; Humans; Latin America; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Nervous System Diseases; Placebos; Prospective Studies; Treatment Outcome

It is uncertain whether all adults with bacterial meningitis benefit from treatment with adjunctive dexamethasone.. We conducted a randomized, double-blind, placebo-controlled trial of dexamethasone in 435 patients over the age of 14 years who had suspected bacterial meningitis. The goal was to determine whether dexamethasone reduced the risk of death at 1 month and the risk of death or disability at 6 months.. A total of 217 patients were assigned to the dexamethasone group, and 218 to the placebo group. Bacterial meningitis was confirmed in 300 patients (69.0%), probable meningitis was diagnosed in 123 patients (28.3%), and an alternative diagnosis was made in 12 patients (2.8%). An intention-to-treat analysis of all the patients showed that dexamethasone was not associated with a significant reduction in the risk of death at 1 month (relative risk, 0.79; 95% confidence interval [CI], 0.45 to 1.39) or the risk of death or disability at 6 months (odds ratio, 0.74; 95% CI, 0.47 to 1.17). In patients with confirmed bacterial meningitis, however, there was a significant reduction in the risk of death at 1 month (relative risk, 0.43; 95% CI, 0.20 to 0.94) and in the risk of death or disability at 6 months (odds ratio, 0.56; 95% CI, 0.32 to 0.98). These effects were not found in patients with probable bacterial meningitis. Results of multivariate analysis indicated that dexamethasone treatment for patients with probable bacterial meningitis was significantly associated with an increased risk of death at 1 month, an observation that may be explained by cases of tuberculous meningitis in the treatment group.. Dexamethasone does not improve the outcome in all adolescents and adults with suspected bacterial meningitis; a beneficial effect appears to be confined to patients with microbiologically proven disease, including those who have received prior treatment with antibiotics. (Current Controlled Trials number, ISRCTN42986828 [controlled-trials.com] .).

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Cerebrospinal Fluid; Dexamethasone; Double-Blind Method; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Kaplan-Meier Estimate; Male; Meningitis, Bacterial; Middle Aged; Multivariate Analysis; Treatment Failure; Vietnam

In sub-Saharan Africa, bacterial meningitis is common and is associated with a high mortality. Adjuvant therapy with corticosteroids reduces mortality among adults in the developed world, but it has not been adequately tested in developing countries or in the context of advanced human immunodeficiency virus (HIV) infection.. We conducted a randomized, double-blind, placebo-controlled trial of dexamethasone (16 mg twice daily for 4 days) and an open-label trial of intramuscular versus intravenous ceftriaxone (2 g twice daily for 10 days) in adults with an admission diagnosis of bacterial meningitis in Blantyre, Malawi. The primary outcome was death at 40 days after randomization.. A total of 465 patients, 90% of whom were HIV-positive, were randomly assigned to receive dexamethasone (233 patients) or placebo (232 patients) plus intramuscular ceftriaxone (230 patients) or intravenous ceftriaxone (235 patients). There was no significant difference in mortality at 40 days in the corticosteroid group (129 of 231 patients) as compared with the placebo group (120 of 228 patients) by intention-to-treat analysis (odds ratio, 1.14; 95% confidence interval [CI], 0.79 to 1.64) or when the analysis was restricted to patients with proven pneumococcal meningitis (68 of 129 patients receiving corticosteroids vs. 72 of 143 patients receiving placebo) (odds ratio, 1.10; 95% CI, 0.68 to 1.77). There were no significant differences between groups in the outcomes of disability and death combined, hearing impairment, and adverse events. There was no difference in mortality with intravenous ceftriaxone (121 of 230 patients) as compared with intramuscular ceftriaxone (128 of 229 patients) (odds ratio, 0.88; 95% CI, 0.61 to 1.27).. Adjuvant therapy with dexamethasone for bacterial meningitis in adults from an area with a high prevalence of HIV did not reduce mortality or morbidity. In this setting, intramuscular administration was not inferior to intravenous administration of ceftriaxone for bacterial meningitis. (Current Controlled Trials number, ISRCTN31371499 [controlled-trials.com].).

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Ceftriaxone; Cerebrospinal Fluid; Dexamethasone; Double-Blind Method; Drug Therapy, Combination; Female; Glucocorticoids; Hearing Loss; Humans; Injections, Intramuscular; Injections, Intravenous; Kaplan-Meier Estimate; Malawi; Male; Meningitis, Bacterial; Neisseria meningitidis; Streptococcus pneumoniae; Treatment Outcome

Cefotaxime (CTX) and ceftriaxone (CRO) were compared for cerebrospinal fluid (CSF) penetration and antimicrobial efficacy in cases of bacterial meningitis in children. This was a comparative study of CRO (100mg/kg once daily) and CTX (50 mg/kg 6 hourly) in the treatment of children with bacterial meningitis. The aetiological agents included Streptococcus pneumoniae (SPn), Haemophilus influenzae type b (Hib) and Neisseria meningitidis (NMen). Minimum inhibitory concentrations (MICs) were measured. In 33 patients from whom a second CSF specimen was obtained, CSF was cultured and assayed for antibiotic concentration. Median MICs of CTX and CRO for SPn, Hib and NMen were 0.01 and 0.01 microg/mL, 0.004 and 0.002 microg/mL and 0.008 and 0.004 microg/mL, respectively. All 33 repeat lumbar puncture specimens were sterile. The lowest CSF level recorded (0.45 microg/mL for CTX) was 45 times the MIC (0.01 microg/mL). The highest levels (24-35 microg/mL for CRO) were up to 8750 times the MIC of the patient's causative organism. A wide range of CSF levels for both antibiotics was observed. Levels varied with post-dose interval and duration of illness. On the basis of these findings, clinicians should be reassured that repeat lumbar puncture is not recommended for the causative organisms in this study (i.e., for Hib, NMen and penicillin/cefotaxime/ceftriaxone fully-susceptible SPn).

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Female; Haemophilus influenzae type b; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal

The purpose of this study was to compare the efficacy of the prophylactic use of ceftriaxone for the prevention of meningitis in patients with acute traumatic pneumocephalus.. In this prospective, single-institution, randomized clinical trial, 109 patients with mild head injury and traumatic pneumocephalus were randomly assigned to receive or not receive an antibiotic medication (ceftriaxone, 1 g given twice a day) until occurrence of meningitis or at least 5 days after trauma. The patients were followed up for 1 month posttrauma. The 109 patients were divided into two groups: 53 were assigned to the prophylactic antibiotics therapy group and 56 to the control group. The overall rate of meningitis was 20.1% and the rates of meningitis in the two groups were not significantly different. The results were the same when adjusted for the patient's Glasgow Coma Scale score, sex, and age, as well as for an intradural location of air, air volume, presence of cerebrospinal fluid (CSF) rhinorrhea or CSF otorrhea, radiological sign of a skull base fracture, or intracranial hemorrhage.. The results of this study do not substantiate the efficacy of ceftriaxone used in the prevention of meningitis in patients with traumatic pneumocephalus after mild head injury or in any specific subgroup of these patients. Cerebrospinal fluid rhinorrhea and intracranial hemorrhage may be considered primary risk factors for the development of meningitis in patients with posttraumatic pneumocephalus and, in the absence of these symptoms, intradural location of air and air volume greater than 10 ml may be considered secondary risk factors. Further studies in this area are warranted.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Ceftriaxone; Female; Follow-Up Studies; Glasgow Coma Scale; Humans; Male; Meningitis, Bacterial; Middle Aged; Pneumocephalus; Prospective Studies

Trough cerebrospinal fluid (CSF) ceftriaxone concentrations were measured daily to investigate the effect of dexamethasone on ceftriaxone penetration into CSF in adult patients with acute bacterial meningitis. Patients were divided into two groups in this double blind randomized study. In group 1 (n=6) patients were given ceftriaxone with dexamethasone whereas in group 2 (n=6) patients were only administered ceftriaxone. Plasma and CSF samples were collected at 24, 48, 72, 96 and 264 h following the study treatments. The trough CSF ceftriaxone concentrations were measured using high performance liquid chromatography (HPLC) and microbiological assay. CSF ceftriaxone concentrations were 3.21 mg/l at 24 h in group 1 and 4.85 mg/l at the same time in group 2 by HPLC. Although microbiological assay results were lower than HPLC the trough CSF ceftriaxone concentrations in dexamethasone group were at least 10(3) times higher than the minimum inhibitory concentrations of the susceptible strains. It was concluded that the ceftriaxone concentration in CSF was adequate and ceftriaxone penetration was not significantly affected by concomitant dexamethasone use in adult patients with acute bacterial meningitis.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Dexamethasone; Drug Interactions; Female; Glucocorticoids; Humans; Male; Meningitis, Bacterial; Middle Aged

Ceftriaxone is recommended in children with acute bacterial meningitis (ABM) for 10 days. However, the drug is expensive, and shorter duration of therapy, if equally effective, would cut costs of therapy and hospitalization. The aim of this study was to compare the outcome of 7 days vs. 10 days' ceftriaxone therapy in children with ABM. Seventy-three children aged 3 months to 12 years with ABM, consecutively admitted to hospital were enrolled. Ceftriaxone was given for 7 days to all. Randomization to group I (7 days) and group II (10 days) therapy was done on the seventh day. At the end of 7 days' therapy in group I and 10 days in group II, children were evaluated using a clinical scoring system. Children with a score of more than 10 were labelled as 'treatment failures' and were continued on ceftriaxone. If a score was less than 10, the antibiotic was stopped. Complications were appropriately evaluated and managed. All children were followed-up 1 month after discharge: neurodevelopmental assessment, Denver Development Screening Tests, IQ and hearing assessment were done. After excluding four patients, there were 35 children in group I and 34 in group II. The two groups were comparable with respect to age, sex, nutritional status, presenting clinical features, and CSF parameters. Organism identification was possible in 38 per cent of children: (Streptococcus pneumoniae, 21 per cent; Haemophilus influenzae, 13 per cent; meningococcus, 4 per cent). Treatment failure rate was comparable in both groups (9 in group I and 8 in group II) as was the sequelae at discharge and at 1 month (9 in group I, 15 in group II,p > 0.1). Status epilepticus and focal deficits at presentation were significantly associated with treatment failures and sequelae in both the groups (p < 0.05). Length of hospital stay was shorter in group I (10.8 +/- 6.0 days) as compared with group II (14.4 +/- 7.2 days,p < 0.05) and frequency of nosocomial infection was significantly more in group II (p < 0.05). It was concluded that clinical outcome of patients treated with 7 days' ceftriaxone therapy is similar to that of 10 days' therapy, and is associated with lesser nosocomial infection and earlier hospital discharge. Seven days ceftriaxone therapy may be recommended for uncomplicated ABM in children in developing countries.

Topics: Ceftriaxone; Cephalosporins; Chi-Square Distribution; Child; Child, Preschool; Drug Administration Schedule; Female; Humans; Infant; Male; Meningitis, Bacterial; Treatment Outcome

Trovafloxacin is a new fluoroquinolone that exhibits good penetration into the central nervous system and excellent antimicrobial activity against common meningeal pathogens, including beta-lactam-resistant pneumococci.. A multicenter, randomized clinical trial was conducted in children with bacterial meningitis to compare the safety and efficacy of trovafloxacin with that of ceftriaxone with or without vancomycin therapy.. A total of 311 patients, ages 3 months to 12 years, were enrolled, of whom 203 were fully evaluable, 108 treated with trovafloxacin and 95 with the conventional regimen. Both groups were comparable with regard to baseline characteristics: age; cerebrospinal fluid findings; use of dexamethasone; history of seizures; and etiologic agents. No significant differences between trovafloxacin and the comparator, respectively, were detected in any of the following outcome measures: clinical success at 5 to 7 weeks after treatment (79% vs. 81%); deaths (2% vs. 3%); seizures after enrollment (22% vs. 21%); and severe sequelae (14% vs. 14%). Only 4 of 284 children developed joint abnormalities up to 6 months after treatment, 1 (0.9%) child received trovafloxacin and 3 (3.1%) received the comparator regimen. None of the evaluable patients experienced significant abnormalities of liver function during treatment. One nonevaluable patient who received trovafloxacin for 5 days and ceftriaxone for 11 days was readmitted to the hospital with hepatitis of unknown etiology 1 day after discharge. The episode resolved with liver function tests returning to normal within 2 months.. We conclude that trovafloxacin is an effective antibiotic for treatment of pediatric bacterial meningitis. These favorable results support further evaluation of fluoroquinolone therapy for children with meningitis or other serious bacterial infections.

Topics: Anti-Infective Agents; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Drug Therapy, Combination; Female; Fluoroquinolones; Humans; Infant; Infusions, Intravenous; Liver; Male; Meningitis, Bacterial; Naphthyridines; Seizures; Treatment Outcome

Seven days or more of antimicrobial treatment is the standard for bacterial meningitis, although third generation cephalosporins are usually able to sterilize cerebrospinal fluid within 24 h. The limited experience from shorter regimens in children is encouraging, and we hypothesized that in rapidly recovering patients older than 3 months of age it would pose no risk for adverse outcome.. Strict clinical and laboratory criteria were used to define rapid initial recovery, in which case ceftriaxone therapy was either stopped after 4 days (4 injections) in children born on even dates (N = 53) or continued for 7 days in patients born on odd dates (N = 47). Outcomes were compared on Day 7 of hospitalization and at 1 to 3 months after discharge.. On Day 7 no differences (P > 0.05 for each criteria) were observed between the 4-day and the 7-day groups regarding fever, clinical signs or serum C-reactive protein concentration. At the follow-up visit 1 to 3 months after discharge the 4-day group had fewer sequelae than the 7-day group (0% vs. 5% neurologic sequelae, P = 0.39 and 3% vs. 9% hearing loss, P = 0.49, respectively). One child in the 4-day group who had fully recovered was subsequently readmitted 53 days after the first hospitalization with recurrent Haemophilus influenzae meningitis.. Four days of ceftriaxone therapy proved to be a safe alternative in patients with rapid initial recovery from bacterial meningitis. A 4-day course of treatment is particularly beneficial for countries with limited resources.

Topics: Ceftriaxone; Cephalosporins; Cerebrospinal Fluid; Child, Preschool; Costs and Cost Analysis; Female; Follow-Up Studies; Humans; Infant; Male; Meningitis, Bacterial; Treatment Outcome

Topics: Ceftriaxone; Child, Preschool; Chloramphenicol; Drug Therapy, Combination; Female; Humans; Infant; Male; Meningitis, Bacterial; Nepal; Penicillins

To assess the value of adjunctive intravenous dexamethasone (DXM) and oral glycerol (GLY) for the treatment of bacteriologically proved bacterial meningitis, 122 infants and children with bacterial meningitis were randomly assigned to receive DXM intravenously (n = 32), GLY orally (n = 30), DXM plus GLY (n = 34) or neither (n = 26) of these drugs. All patients were treated with the same antimicrobial agent, ceftriaxone. The patients were followed neurologically for as long as 6 months. A thorough hearing evaluation was performed routinely 2 months or more after discharge from hospital. Overall 4 (7%) of the GLY-treated patients, compared with 11 (19%) of those not given GLY, developed audiologic or neurologic sequelae (P = 0.052), the relative risk of sequelae being 2.94 (95% confidence interval, 0.99 to 8.72). The patients who had received GLY showed less severe or profound bilateral hearing impairment than those not given GLY (0 vs. 7%, P = 0.049), and none of them had other neurologic abnormalities 3 or 6 months after discharge, compared with 5 (9%) of those not treated with GLY (P = 0.024). The DXM recipients showed only a tendency to less severe hearing impairment than those not given DXM. In conclusion oral GLY prevented neurologic sequelae in infants and children with bacterial meningitis more effectively than intravenous DXM.

Topics: Administration, Oral; Adolescent; Ceftriaxone; Child; Child, Preschool; Confidence Intervals; Dexamethasone; Drug Therapy, Combination; Female; Glycerol; Hearing Disorders; Humans; Infant; Injections, Intravenous; Male; Meningitis, Bacterial; Nervous System Diseases; Treatment Outcome

To determine whether treatment with dexamethasone and ceftriaxone for children with bacterial meningitis reduces the frequency of either sensorineural hearing loss or other neurologic sequelae.. This was a prospective, multicentered, placebo-controlled clinical trial. Subjects were followed for 1 year.. The study was conducted in six children's hospitals located in Pittsburgh, Houston, Los Angeles, Chicago, Washington, D.C., and Columbus, Ohio.. Enrolled were 173 children, 8 weeks to 12 years of age, with suspected bacterial meningitis; 143 children were evaluable. Eighty-seven percent of patients were followed for at least 6 weeks to 3 months, and 67% were followed for 1 year.. Subjects were randomized to receive ceftriaxone with or without dexamethasone (0.15 mg/kg every 6 hours for 4 days). Auditory brainstem responses (ABR) were measured within 24 hours of admission.. Hearing, development, and neurologic sequelae were assessed at the time of discharge and 6 weeks and 1 year later.. One hundred forty-three patients (69 received dexamethasone and 74 received placebo) with bacterial meningitis were evaluable: Haemophilus influenzae type b (83), Streptococcus pneumoniae (33), Neisseria meningitidis (24), and three others. Overall, there was no significant difference in auditory outcome between dexamethasone and placebo recipients. Twenty-two children had bilateral moderate or more severe hearing loss at the time of the first ABR. At follow-up, the resolution of hearing impairment was nearly identical for each group. Nine of ten children who remained persistently deaf were deaf at the time of the first ABR. There were no differences in neurologic or developmental outcome between groups.. All but one child with persistent bilateral moderate or more severe hearing loss had demonstrable deafness at the time of the first ABR. Dexamethasone did not significantly improve audiologic, neurologic, or developmental outcome in children with bacterial meningitis.

Topics: Ceftriaxone; Child; Child Development; Child, Preschool; Deafness; Dexamethasone; Drug Therapy, Combination; Female; Hearing Loss, Sensorineural; Humans; Infant; Male; Meningitis, Bacterial; Nervous System Diseases; Prospective Studies

Third-generation cephalosporins are presently the agents of choice for the empirical antimicrobial therapy of bacterial meningitis. However, a number of factors associated with these agents, namely the development of resistance by pneumococci, limited activity against some Enterobacteriaceae and Pseudomonas spp., and the possible adverse effects of their bacteriolytic mode of action, indicate that newer classes of antimicrobial agents be evaluated for the treatment of bacterial meningitis. Meropenem is a carbapenem antibiotic which is highly active against the major bacterial pathogens causing meningitis, and penetrates well into the cerebrospinal fluid. Two prospective randomised studies in 56 adult bacterial meningitis patients have compared meropenem 40 mg/kg 8-hourly, up to a maximum of 6 g/day (n = 28) with cephalosporin treatment, i.e. cefotaxime (n = 17) or ceftriaxone (n = 11). Patients were assessed by neurological examination, Glasgow Coma Score and Herson-Todd score. Clinical cure was observed in all 23 evaluable patients treated with meropenem (100%) and with 17 of the 22 evaluable cephalosporin-treated patients (77%). All pre-treatment isolates were eradicated except one isolate of Staphylococcus aureus in a cefotaxime-treated patient. Neurological sequelae were noted in three meropenem and four cephalosporin-treated patients. No patients in either treatment group experienced seizures after the start of therapy. This was despite the fact that a patient in each group had experienced seizures before therapy, several had underlying CNS disorders, and that doses of 6 g/day of meropenem were given. Hearing impairment was recorded in 11 meropenem and nine cephalosporin treated patients. Three patients in the meropenem group and one in the cephalosporin group died during treatment for reasons unrelated to study therapy. Overall, the results of this study indicate that meropenem is an effective and well-tolerated antibiotic for the treatment of bacterial meningitis in adults.

Topics: Adult; Carbapenems; Cefotaxime; Ceftriaxone; Humans; Meningitis, Bacterial; Meropenem; Thienamycins; Treatment Outcome

Antibiotic therapy is administered intravenously to children with bacterial meningitis to achieve the highest possible blood and cerebrospinal fluid (CSF) concentrations. However, intravenous access for the entire duration of therapy may be difficult in some children. Intramuscular therapy offers a more versatile option; however, CSF concentrations and bactericidal activity following im injection in children concurrently treated with dexamethasone have not been studied. We prospectively evaluated 37 children given an im dose of ceftriaxone on either the 3rd, 6th or 9th day of antibiotic therapy while receiving dexamethasone for the first 4 days of treatment. All children were required to have normal peripheral perfusion at the time of im injection. Four to 6 hours after im injection CSF was obtained. The average age of study patients was 28 months; Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type b were responsible for 95% of all infections. All children studied had detectable CSF ceftriaxone concentrations, with mean (+/- SD) concentrations (microgram/ml) on Days 3, 6 and 9 of therapy of 5.7 +/- 5.5 (n = 12), 5.2 +/- 5.0 (n = 14) and 2.0 +/- 2.6 (n = 10), respectively. All CSF bactericidal titers for N. meningitidis, S. pneumoniae and H. influenzae type b, regardless of day of im injection, were > or = 1:64. Intramuscular ceftriaxone therapy of bacterial meningitis may be a reasonable therapeutic option for the convalescing child with good peripheral perfusion.

Topics: Ceftriaxone; Child; Child, Preschool; Dexamethasone; Drug Administration Schedule; Drug Interactions; Drug Therapy, Combination; Female; Humans; Infant; Injections, Intramuscular; Male; Meningitis, Bacterial; Prospective Studies; Serum Bactericidal Test; Treatment Outcome

Because studies of the treatment of children with occult bacteremia have yielded conflicting results, we compared ceftriaxone with amoxicillin for therapy. Inclusion criteria were age 3 to 36 months, temperature > or = 39 degrees C, an acute febrile illness with no focal findings or with otitis media (6/10 centers), and culture of blood. Subjects were randomly assigned to receive either ceftriaxone, 50 mg/kg intramuscularly, or amoxicillin, 20 mg/kg/dose orally for six doses. Of 6733 patients enrolled, 195 had bacteremia and 192 were evaluable: 164 Streptococcus pneumoniae, 9 Haemophilus influenzae type b, 7 Salmonella, 2 Neisseria meningitidis, and 10 other. After treatment, three patients receiving amoxicillin had the same organism isolated from their blood (two H. influenzae type b, one Salmonella) and two from the spinal fluid (two H. influenzae type b), compared with none given ceftriaxone. Probable or definite infections occurred in three children treated with ceftriaxone and six given amoxicillin (adjusted odds ratio 0.43, 95% confidence interval 0.08 to 1.82, p = 0.31). The five children with definite bacterial infections (three meningitis, one pneumonia, one sepsis) received amoxicillin (adjusted odds ratio 0.00, 95% confidence interval 0.00 to 0.52, p = 0.02). Fever persisted less often with ceftriaxone (adjusted odds ratio 0.52, 95% confidence interval 0.28 to 0.94, p = 0.04). Although the difference in total infections was not significant, ceftriaxone eradicated bacteremia, prevented significantly more definite focal bacterial complications, and was associated with less persistent fever.

Topics: Administration, Oral; Amoxicillin; Arthritis, Infectious; Bacteremia; Ceftriaxone; Child, Preschool; Fever; Humans; Infant; Injections, Intramuscular; Meningitis, Bacterial; Microbial Sensitivity Tests; Osteomyelitis; Otitis Media; Pneumonia; Prospective Studies

Routine use of steroids as adjunctive treatment of bacterial meningitis remains controversial. We have carried out a prospective, placebo-controlled, double-blind study of dexamethasone in 115 children with acute bacterial meningitis in Switzerland. The patients were randomly assigned to receive either placebo (n = 55) or dexamethasone (n = 60) in addition to optimum antibiotic treatment (100 mg/kg daily ceftriaxone). Dexamethasone therapy (0.4 mg/kg) was started 10 min before the first dose of ceftriaxone and given every 12 h for 2 days. Baseline demographic, clinical, and laboratory features of the two groups were similar. After 24 h treatment meningeal inflammation as shown by cerebrospinal fluid (CSF) glucose concentration was significantly less with dexamethasone than with placebo (mean increase in glucose 63 [76] vs 40 [75]%, p = 0.008). However, other indices of inflammation showed similar changes in both groups. Addition of dexamethasone did not affect the rate at which CSF became sterile. Both groups showed prompt clinical responses and similar frequencies of complications (15 vs 12%). Monitoring for possible adverse effects of dexamethasone revealed no abnormalities. At follow-up examinations 3, 9, and 15 months after hospital discharge, 9 (16%) of 55 placebo recipients and 3 (5%) of 60 dexamethasone recipients had one or more neurological or audiological sequelae (p = 0.066); the relative risk of sequelae was 3.27 (95% CI 0.93-11.47). Our results and those of similarly designed studies lead us to believe that adjunctive dexamethasone therapy improves outcome from bacterial meningitis in infants and children. We recommend its use, preferably in the dose regimen used in this study.

Topics: Adolescent; C-Reactive Protein; Ceftriaxone; Child; Child, Preschool; Dexamethasone; Double-Blind Method; Drug Administration Schedule; Drug Combinations; Hearing Loss, Sensorineural; Humans; Infant; Injections, Intravenous; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Placebos; Prospective Studies; Risk Factors

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Female; Finland; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cephalosporins; Humans; Meningitis; Meningitis, Bacterial; Meningitis, Pneumococcal; Microbial Sensitivity Tests

Topics: Cefotaxime; Ceftriaxone; Humans; Meningitis; Meningitis, Bacterial

Streptococcus suis is an emerging zoonotic pathogen. Human infections with S suis have been identified in Europe, North America, South America, Oceania, Africa and Asia. As the most common clinical symptom of human S suis, meningitis develops in 50% to 60% of infected patients, and approximately 60% of the patients with meningitis symptoms have neurologic sequelae. The cost of infection with S suis imposes a tremendous burden on patients' families.. A 56-year-old woman was infected with S suis. The patient reared pigs in her backyard. At admission, her blood examination showed a leukocyte count of 27.28 × 109/L with 94.20% neutrophils. Cerebrospinal fluid was cloudy with a leukocyte count of 2700 × 106/L. Cerebrospinal fluid cultures revealed gram-positive cocci identified as S suis type II. Ceftriaxone was then administered.. Human infections with S suis highlights the need for health education, prevention and surveillance it.

Topics: Animals; Ceftriaxone; China; Humans; Meningitis; Meningitis, Bacterial; Middle Aged; Streptococcal Infections; Streptococcus suis; Swine

Salmonella meningitis is a rare but serious complication of Salmonella infection, primarily affecting infants, children, and immunocompromised individuals.. We present a case of a two-and-a-half-year-old Asian boy who developed Salmonella meningitis along with pneumonia and respiratory failure. Initially, he experienced symptoms of loose motions, fever, and irritability, which progressed to neck stiffness and brisk reflexes. Cerebrospinal fluid (CSF) analysis confirmed Salmonella typhi in the CSF. Due to the worsening condition, the patient was admitted to the intensive care unit, intubated, and switched to meropenem as the antibiotic of choice after an initial empiric therapy with ceftriaxone and vancomycin. With appropriate treatment, the patient showed significant improvement, including resolution of fever and respiratory symptoms.. Management of Salmonella meningitis is often challenging primarily because of the fact that the empiric therapy for meningitis may not always provide coverage to the multi-drug resistant Salmonella species found in South Asia. Prompt administration of appropriate antibiotics based on sensitivity testing is crucial for successful management. This case emphasizes the importance of early recognition and effective management of this uncommon yet severe complication of Salmonella infection.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Fever; Humans; Infant; Male; Meningitis, Bacterial; Pakistan; Salmonella Infections; Salmonella typhi

Treatment of acute bacterial meningitis is difficult due to the impermeability of the blood-brain barrier, greatly limiting the antibiotic concentrations that can be achieved in the brain. Escherichia coli grown in presence of iron-oxide magnetic nanoparticles secrete large amounts of magnetic outer-membrane vesicles (OMVs) in order to remove excess Fe from their cytoplasm. OMVs are fully biomimetic nanocarriers, but can be inflammatory. Here, non-inflammatory magnetic OMVs were prepared from an E. coli strain in which the synthesis of inflammatory lipid A acyltransferase was inhibited using CRISPR/Cas9 mediated gene knockout. OMVs were loaded with ceftriaxone (CRO) and meso-tetra-(4-carboxyphenyl)porphine (TCPP) and magnetically driven across the blood-brain barrier for sonodynamic treatment of bacterial meningitis. ROS-generation upon ultrasound application of CRO- and TCPP-loaded OMVs yielded similar ROS-generation as by TCPP in solution. In vitro, ROS-generation by CRO- and TCPP-loaded OMVs upon ultrasound application operated synergistically with CRO to kill a hard-to-kill, CRO-tolerant E. coli strain. In a mouse model of CRO-tolerant E. coli meningitis, CRO- and TCPP-loaded OMVs improved survival rates and clinical behavioral scores of infected mice after magnetic targeting and ultrasound application. Recurrence did not occur for at least two weeks after arresting treatment.

Topics: Animals; Anti-Bacterial Agents; Bacterial Outer Membrane Proteins; Ceftriaxone; Escherichia coli; Meningitis, Bacterial; Mice; Reactive Oxygen Species

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Contrast Media; Cranial Nerve Diseases; Diplopia; Female; Gadolinium; Humans; Immunoglobulin G; Leukocytosis; Meningitis, Bacterial; Oligoclonal Bands; Paralysis; Prednisolone

Children with nephrotic syndrome are at increased risk of infections, including bacterial peritonitis, pneumonia, and cellulitis. However, bacterial meningitis, a potentially life-threatening complication, has not been highlighted as an infectious complication of nephrotic syndrome in recent reviews. We report a very subtle and unusual presentation of bacterial meningitis in a child with nephrotic syndrome, which without a high index of suspicion, would have been missed.. A 9-year-old African-American male with a history of steroid-dependent nephrotic syndrome presented to the nephrology clinic for routine follow-up. His medications included mycophenolate mofetil and alternate-day steroids. His only complaint was neck pain and stiffness that the mother attributed to muscle tightness relieved by massage. There was no history of fever, vomiting, headache, photophobia, or altered mental status. On physical examination, he was afebrile (99 °F), but had mild periorbital swelling and edema on lower extremities. He appeared ill and exhibited neck rigidity, and demonstrated reflex knee flexion when the neck was bent. Laboratory evaluation revealed leukocytosis, elevated C-reactive protein, hypoalbuminemia, and proteinuria. Cerebrospinal fluid suggested bacterial meningitis. The patient was treated with ceftriaxone and vancomycin. Both cerebrospinal and blood cultures grew Streptococcus pneumoniae; vancomycin was discontinued. The child completed a 2-week course of ceftriaxone and was discharged home.. A high index of suspicion is necessary in children with nephrotic syndrome treated with corticosteroids, as symptoms may be masked, and thus, a life-threatening disease be missed. Bacterial meningitis should be highlighted as a serious infection complication in children with nephrotic syndrome.

Topics: Ceftriaxone; Child; Humans; Male; Meningitis, Bacterial; Meningitis, Pneumococcal; Nephrotic Syndrome; Vancomycin

BACKGROUND We present a case of Group B Streptococcus (Streptococcus agalactiae or GBS) meningitis in a non-pregnant woman that likely originated from acute otitis media. Although invasive Group B Streptococcal infections are increasing in the United States, GBS meningitis is still rare in non-pregnant adults. At the end, we discuss risk factors for this disease and data that suggest that invasive GBS infection is increasing in the adult and elderly populations of the United States. CASE REPORT Our patient was a 55-year-old woman with a history of juvenile rheumatoid arthritis who presented with altered mental status after failure of outpatient treatment of otitis media with oral doxycycline and steroids. Upon admission, she was initially afebrile and hemodynamically stable, but she had a rapid decline and required emergent intubation. Blood cultures grew GBS. CSF PCR analysis performed by BioFire® FilmArray® Meningitis/Encephalitis Panel revealed GBS. Middle-ear fluid and CSF cultures drawn after 1 day of antibiotic therapy did not grow any organisms. Treatment was achieved with high-dose intravenous ceftriaxone for 14 days, and tympanoplasty. At the end of 14 days of antibiotic therapy, the patient had full neurological recovery, without any residual neurological deficits. CONCLUSIONS GBS meningitis is classically associated with neonatal disease, but invasive GBS infection is fairly common in adults and appears to be increasing in incidence secondary to increasing populations living with diabetes, immunosuppressed conditions, and advanced age. Central nervous system infection with this organism is still rare. In this case report we describe a non-pregnant woman who presented with GBS meningitis.

Topics: Adult; Aged; Ceftriaxone; Female; Humans; Infant, Newborn; Meningitis, Bacterial; Middle Aged; Otitis Media; Streptococcal Infections; Streptococcus agalactiae

We present a case of a 75-year-old woman with Austrian syndrome: pneumonia, meningitis and endocarditis all due to

Topics: Aged; Agranulocytosis; Anti-Bacterial Agents; Ceftriaxone; Comorbidity; COVID-19; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Humans; Meningitis, Bacterial; Pandemics; Pneumococcal Infections; SARS-CoV-2; Streptococcus pneumoniae; Syndrome

Campylobacter fetus is an uncommon Campylobacter species, and its infections mainly cause infective endocarditis, aortic aneurysm, and meningitis rather than enteritis. It is more likely to be detected in blood than Campylobacter jejuni or Campylobacter coli, specifically reported in 53% of patients. In our case, C. fetus was detected in both blood and cerebrospinal fluid (CSF) cultures.. A 33-year-old woman, who was on maintenance chemotherapy for acute lymphoblastic leukemia (ALL), presented to our clinic with chief complaints of severe headache and nausea. Blood and CSF cultures revealed C. fetus. We administrated meropenem 2 g intravenously (IV) every 8 h for 3 weeks, and she was discharged without neurological sequelae.. We encountered a case of C. fetus meningitis without gastrointestinal symptoms, neck stiffness or jolt accentuation in a patient with ALL. Undercooked beef was considered the source of C. fetus infection in this case, suggesting that the need for a neutropenic diet and safe food handling be considered.

Topics: Adult; Anti-Bacterial Agents; Campylobacter fetus; Campylobacter Infections; Ceftriaxone; Diagnosis, Differential; Drug Therapy; Drug-Related Side Effects and Adverse Reactions; Female; Foodborne Diseases; Humans; Meningitis, Bacterial; Meropenem; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Treatment Outcome

Bacterial meningitis is a serious inflammation of the meninges. Antimicrobial therapy on early cerebrospinal fluid (CSF) examination has an important role in diagnosis. The disease is still challenging in developing countries because of poor (diagnostic set-up, socioeconomic conditions, management), and misuse of antimicrobial therapy results in emerging antimicrobial-resistant strains. Therefore, this hospital based cross sectional study was aimed to assess the antimicrobial sensitivity profile and bacterial isolates among patients suspected of pyogenic meningitis at Hawassa University Hospital from February 2017 to 2018.. A total of 394 patients suspected as meningitis were included. Of these 210 (53.3%) were males and 184 (46.7%) were females. The carriage rate of bacterial pathogens was 27(6.9%). The common clinical presentations were fever 330 (83.8%), headache 205 (52.0%) and neck stiffness 179(45.4%) followed by altered mental status 125(31.7%). Neck stiffness P = 0.001 (AOR = 1.18, 95% CI 1.06-6.53), Hx of seizure P = 0.043, (AOR = 1.39, 95% CI 1.15-5.99), Nuchal rigidity P = 0.001* (AOR = 1.26, 95% CI 1.06-4.48) were significantly associated with culture positivity. The pathogens isolated in this study were N. meningitidis the most frequent isolate 12(44.4%) followed by S. pneumoniae 5 (18.5%), E. coli 4(14.8%), H. influenza 3(13.6%), S. aureus 2(11.1%) and K. pneumoniae 1(3.7%). S. pneumoniae was (100%) resistance to penicillin, (80%) amoxicillin, and (20%) Cefotaxime. S. aureus was (100%) resistant to penicillin, amoxicillin, and ciprofloxacin. N. meningitidis was (100%) resistant to penicillin, (66.7%) Ceftriaxone and (41.7%) chloramphenicol. In this study a single isolate was also resistant to a different antibiotic.. The prevention of bacterial meningitis needs serious attention since the isolated bacteria showed single and multiple antimicrobial susceptibility patterns and the variable nature of isolated etiological agents makes it reasonable to provide continuous future updates on local resistance of common antibiotics and optimize the most frequent bacteria associated with meningitis in the hospital. Therefore; further, survey study with a better design of antimicrobial susceptibility at large scale to control the spread of antibiotic-resistant bacteria and the change in the causative organism of bacterial meningitis in the study area and at a national level is required.

Topics: Adolescent; Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Bacteria; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Ciprofloxacin; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Female; Hospitals, University; Humans; Infant; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Middle Aged; Penicillins; Phylogeny; Young Adult

Topics: Administration, Intravenous; Adolescent; Anti-Bacterial Agents; Brain; Ceftriaxone; Central Nervous System Viral Diseases; Diagnosis, Differential; Diarrhea; Flushing; Guillain-Barre Syndrome; Headache; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Irritable Mood; Lyme Neuroborreliosis; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Myelitis; Neck Pain; Paresthesia; Peroneal Neuropathies; Pneumonia, Bacterial; Reflex, Abnormal; Spinal Cord; Sweating; Urinary Retention; West Nile Fever

Topics: Aged; Anti-Bacterial Agents; Anticonvulsants; Ceftriaxone; Diabetes Mellitus, Type 2; Electroencephalography; Female; Humans; Levetiracetam; Meningitis, Bacterial; Seizures; Streptococcal Infections; Streptococcus agalactiae

Streptococcus oralis belongs to the Streptococcus mitis group and is part of the normal flora of the nasal and oropharynx (Koneman et al., The Gram-positive cocci part II: streptococci, enterococci and the 'Streptococcus-like' bacteria. Color atlas and textbook of diagnostic microbiology, 1997). Streptococcus oralis is implicated in meningitis in patients with decreased immune function or from surgical manipulation of the central nervous system. We report a unique case of meningitis by Streptococcus oralis in a 58-year-old patient with cerebral spinal fluid leak due to right sphenoid meningoencephalocele.. A 58-year-old female presented in the emergency department due to altered mental status, fevers, and nuchal rigidity. Blood cultures were positive for Streptococcus oralis. Magnetic resonance stereotactic imaging of head with intravenous gadolinium showed debris in lateral ventricle occipital horn and dural thickening/enhancement consistent with meningitis. There was also a right sphenoidal roof defect, and meningoencephalocele with cerebrospinal fluid leak as a result. The patient was treated with ceftriaxone and had endoscopic endonasal repair of defect. She had complete neurologic recovery 3 months later.. Cerebrospinal fluid leak puts patients at increased risk for meningitis. Our case is unique in highlighting Streptococcus oralis as the organism implicated in meningitis due to cerebrospinal fluid leak.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cerebrospinal Fluid Leak; Encephalocele; Endoscopy; Female; Humans; Meningitis, Bacterial; Meningocele; Middle Aged; Nasal Surgical Procedures; Sphenoid Bone; Streptococcal Infections; Streptococcus oralis; Treatment Outcome

Leptospirosis is a reemerging zoonosis with a worldwide distribution and a wide range of clinical manifestations. We report a case of leptospirosis meningitis in a previously healthy woman infected by her pet mouse.. A 27-year-old Caucasian woman with pet mice presented to our institute with a 1 week history of fever, headache, myalgia, vomiting, diarrhea, and dark urine. Her admission examination revealed neck stiffness, conjunctivitis, and icteric sclera. Her liver enzymes, bilirubin, white blood cell count, and C-reactive protein were elevated. Her cerebrospinal fluid showed an elevated white blood cell count. Polymerase chain reactions using her cerebrospinal fluid, blood, and urine showed negative results for leptospirosis, but the result of her microagglutination test was positive for Leptospira interrogans serovar sejroe with a more than threefold increase in paired sera. The patient was treated with ceftriaxone for 1 week, and her condition steadily improved.. This case report raises awareness of pet rodents as sources of leptospirosis. Leptospirosis meningitis should be considered in patients with meningeal symptoms and pet rodents.

Topics: Adult; Animals; Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Leptospira interrogans; Leptospirosis; Meningitis, Bacterial; Mice; Pets; Rodent Diseases; Zoonoses

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Humans; Male; Meningitis, Bacterial; Streptococcal Infections; Streptococcus salivarius; Treatment Outcome

The use of empiric vancomycin plus a third-generation cephalosporin for suspected bacterial meningitis has been recommended since 1997. Although the prevalence of ceftriaxone-nonsusceptible pneumococcal meningitis has decreased, vancomycin should still be included as empiric therapy for bacterial meningitis.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Humans; Meningitis, Bacterial; Meningitis, Pneumococcal; Microbial Sensitivity Tests; Streptococcus pneumoniae; Vancomycin

An 80-year-old man who had chronic heart failure and atrial fibrillation was refered to our hospital because of acute onset of fever and consciousness disturbance. Neurological examinations revealed deteriorated consciousness, nuchal rigidity and Kernig's sign. A lumber puncture yielded clouded fluid with a WBC 11,200/μl (polynuclear cell 94%), 758 mg/dl of protein, 1 mg/dl of glucose, 0.007 of cerebrospinal fluid-blood glucose ratio and Gram positive cocci. Diffusion-weighted images on brain MRI showed no signal intensity in bilateral ventricles at admission. He was treated with ceftriaxon, vancomycin and ampicillin. Streptococcus salivarius (S. salivarius) was isolated from blood and cerebrospinal fluid. He responded promptly to antibiotics therapy, and within 5 days, he became lucid and afebrile. S. salivarius was sensitive for ceftriaxone, vancomycin and ampicillin. After Day 6, he was treated with ceftriaxone only. We diagnosed his condition as S. salivarius meningitis. He discharged from our hospital at Day 22. Many cases of S. salivarius meningitis were occurred in second and fifth decade. But elderly case was rare. Neurologist should consider that elderly case with bacterial meningitis was caused by S. salivarius.

Topics: Age Factors; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Diffusion Magnetic Resonance Imaging; Drug Therapy, Combination; Humans; Male; Meningitis, Bacterial; Streptococcal Infections; Streptococcus salivarius; Treatment Outcome; Vancomycin

We measured ceftriaxone pharmacokinetics in patients' plasma and cerebrospinal fluid (CSF) and assessed the influence of biometric, demographic, genetic (ABCB1, ABCC2, ABCB11, ABCG2, and SLCO1A2 polymorphisms) and pathological features. Adult patients with signs and symptoms of central nervous system infections, receiving intravenous ceftriaxone, were enrolled. Ceftriaxone plasma and CSF concentrations were measured by high-precision liquid chromatographic methods; allelic discrimination was performed by real-time polymerase chain reaction. Forty-three patients were included: median ceftriaxone maximal concentration was 15,713 ng/mL in plasma and 3512 ng/mL in CSF with a CSF-to-plasma ratio of 0.3. ABCC2 1249 rs2273697 (P = .027) and ABCG2 1194+928 rs13120400 (P = .015) variants were significantly associated with CSF concentrations and CSF-to-plasma ratios. At linear regression analysis, CSF-to-serum albumin ratio was an independent predictor of ceftriaxone CSF concentrations (P = .001; also in those with intact blood-brain barrier: P = .031) and CSF-to-plasma ratio (P = .001; also in those with blood-brain barrier impairment: P = .040). We here report the role of transporters' genetic variants as well as of blood-brain barrier permeability in predicting ceftriaxone exposure in the central nervous system.

Topics: Adult; Aged; Anti-Bacterial Agents; ATP Binding Cassette Transporter, Subfamily G, Member 2; Ceftriaxone; Female; Humans; Male; Meningitis, Bacterial; Middle Aged; Multidrug Resistance-Associated Protein 2; Multidrug Resistance-Associated Proteins; Neoplasm Proteins; Polymorphism, Single Nucleotide

Non-traumatic cerebrospinal fluid (CSF) rhinorrhoea is a rare condition. We describe a case of a 62-year-old woman with pneumococcal bacterial meningitis who later was found to have CSF rhinorrhoea secondary to an eroding skull base tumour, which was proven to be pituitary macroadenoma on biopsy. She recovered well from meningitis without any neurological sequelae and underwent trans-sphenoidal surgery for tumour removal as well as dural repair.

Topics: Adenoma; Anti-Bacterial Agents; Ceftriaxone; Cerebrospinal Fluid Rhinorrhea; Female; Humans; Meningitis, Bacterial; Middle Aged; Pituitary Neoplasms; Skull Base Neoplasms; Tomography, X-Ray Computed

To explore the clinical characteristics and etiology of bacterial meningitis (BM) in Chinese children.. BM cases in children 28days to 18 years old were collected from January 2014-December 2016 and screened according to World Health Organization standards. Clinical features, pathogens, and resistance patterns were analyzed.. Overall, 837 cases were classified into five age groups: 28 days-2 months (17.0%), 3-11 months (27.8%), 12-35 months (24.0%), 3-6 years (13.9%), and >6years (17.3%). Major pathogens were Streptococcus pneumoniae (S. pneumoniae, n=136, 46.9%), group B Streptococcus (GBS, n=29, 10.0%), and Escherichia coli (E. coli, n=23, 7.9%). In infants <3 months old, GBS (46.5%) and E. coli (23.3%) were most common; in children >3 months old, S. pneumoniae (54.7%), which had a penicillin non-susceptibility rate of 55.4% (36/65), was most frequent. The resistance rates of S. pneumoniae and E. coli to cefotaxime and ceftriaxone were 14.0%/40.0% and 11.3%/68.4%, respectively. All GBS isolates were sensitive to penicillin.. The occurrence of BM peaked in the first year of life, while S. pneumoniae was the predominant pathogen in children >3months of old. The antibiotic resistance of S. pneumoniae was a concern.

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; China; Drug Resistance, Bacterial; Escherichia coli; Female; Humans; Infant; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Penicillin G; Retrospective Studies; Streptococcus agalactiae; Streptococcus pneumoniae

Iatrogenic cerebrospinal fluid (CSF) rhinorrhea in a bilateral frontal decompressive craniectomy patient triggered by strenuous sport is rare. To the best of our knowledge, no similar case has yet been reported.. Herein, we report a case of CSF rhinorrhea in a 37-year-old man. He had previously suffered a traumatic brain injury in a traffic accident, and a subsequent bilateral frontal decompressive craniectomy operation was performed. Based on the frontal skull defect peculiarity, strenuous exercise may have caused drastic CSF pressure waves to tear the dura mater of the anterior skull base, resulting in CSF rhinorrhea.. The thin-slice computerized tomography (CT) images revealed a frontal skull defect and the open frontal sinus. In addition, in the opened frontal sinus, low-density liquid-filled areas were visible.. During surgery, the torn dura was carefully repaired, and the frontal sinus was filled with temporal muscle, fascia, and fibrin glue. A simultaneous cranioplasty was performed.. The patient was followed-up postoperatively for 12 months to date without rhinorrhea recurrence. Recovery was uneventful.. Patients with skull defects should avoid strenuous sports, and cranioplasty should be performed as early as possible in order to decrease the likelihood of a dural tear and prevent the occurrence of CSF leakage. After cranioplasty, the skull should be restored to a closed state to reduce the damaging effects of CSF waves during movement. It is important to maintain normal intracranial pressure to reduce the recurrence rate of CSF rhinorrhea.

Topics: Accidents, Traffic; Adult; Anti-Bacterial Agents; Brain Injuries, Traumatic; Ceftriaxone; Cerebrospinal Fluid Rhinorrhea; Decompressive Craniectomy; Dura Mater; Exercise; Frontal Sinus; Humans; Male; Meningitis, Bacterial; Pneumococcal Infections; Postoperative Complications; Skull Base

We report a case of recrudescent Streptococcus suis meningitis requiring a prolonged treatment course. A few similar cases can be found in the burgeoning literature on what remains a relatively uncommon disease in humans, and these patients should be monitored carefully upon completion of therapy.

Topics: Adult; Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Female; Follow-Up Studies; Humans; Meningitis, Bacterial; Recurrence; Streptococcal Infections; Streptococcus suis; United States

Topics: Adult; Anti-Bacterial Agents; Bacteriological Techniques; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Infant; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Middle Aged; Salmonella; Salmonella Infections; Treatment Outcome

The burden of disease from bacterial meningitis is highest in low-income countries (1). Early initiation of antibiotic therapy is important in reducing the risk for mortality. Current treatment guidelines recommend the use of an expanded-spectrum cephalosporin (cefotaxime or ceftriaxone) (2), but these therapies increasingly are limited by drug resistance, and are threatened by the proliferation of substandard and falsified medicines (3,4). In February 2013, a case of bacterial meningitis following a middle ear infection was diagnosed in an adolescent at the Mulago National Referral Hospital in Kampala, Uganda. Once-daily treatment with 2 g of intravenous ceftriaxone administered according to guidelines failed, and the patient died. To determine whether the patient's treatment failure and subsequent death might be related to the ceftriaxone product administered, a sealed vial similar to the one administered to the patient was analyzed at the University of Ottawa, Canada, and was found to contain only 0.455 g of the drug, not 1 g as stated by the manufacturer. This would have resulted in subtherapeutic dosing. Substandard medicines are a global problem that disproportionately affects low-income countries, leading to fatal consequences and promoting the emergence of drug resistance (4).

Topics: Adolescent; Ceftriaxone; Fatal Outcome; Humans; Male; Meningitis, Bacterial; Uganda

A 40-year-old man with chronic myelogenous leukemia presented multiple times over a period of 3 years with episodes of confusion, wide-based gait and falls because of recurrent hydrocephalus despite repeated therapeutic lumbar punctures. These problems occurred in the context of persistent cerebrospinal fluid (CSF) pleocytosis and leptomeningeal enhancement. Extensive diagnostic workups and therapeutic trials had failed to identify a clinically plausible cause or produce any significant improvement in the CSF and neuroimaging abnormalities.. We used high-throughput metagenomic shotgun sequencing to identify microbes in 2 CSF samples collected from the patient during his illness. These results were compared to sequence data from 1 CSF sample collected during treatment and 5 control CSF samples from other patients.. We found sequences representing 53% and 67% of the Propionibacterium acnes genome in 2 CSF samples collected from the patient during his illness. Directed antimicrobial therapy was administered for 6 weeks with resolution of CSF and neuroimaging abnormalities. Sequencing of a sample obtained during treatment demonstrated that the P. acnes levels were decreased to background levels. After insertion of a ventriculo-peritoneal shunt, the patient returned to baseline status.. High-throughput metagenomic shotgun sequencing revealed P. acnes as the cause of chronic meningitis that had eluded conventional attempts at diagnosis. Treatment directed at this organism resulted in cure of the infection and clinical improvement.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Chronic Disease; Gram-Positive Bacterial Infections; High-Throughput Nucleotide Sequencing; Humans; Immunocompromised Host; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Meningitis, Bacterial; Propionibacterium acnes; Stem Cell Transplantation; Transplantation, Homologous

Borrelia recurrentis, transmitted by Pediculus humanus humanus, is the etiological agent of louse-borne relapsing fever (LBRF). Currently the main focus of endemicity of LBRF is localized in East African countries. From July 2015 to October 2015, 36 cases of LBRF have been diagnosed in Europe in immigrants from the Horn of Africa. Here we report a case of LBRF with meningitis diagnosed in Florence, Italy, in an immigrant arrived from Somalia.. In October 2015, a 19-year-old Somali male presented to the emergency department of the Azienda Ospedaliero Universitaria Careggi, Florence, Italy, with a 3-day history of high fever. The patient had disembarked in Sicily 10 days before admission after a long migration trip from his country of origin. On clinical examination, neck stiffness was found. Main laboratory findings were thrombocytopenia, increased procalcitonin, and increased polymorphonucleates in the cerebrospinal fluid. Suspecting a possible meningitis, the patient was treated with ceftriaxone, pending results of laboratory testing for malaria, and developed severe hypotension that was treated with fluid resuscitation and hydrocortisone. Hemoscopic testing revealed the presence of spirochetes and no malaria parasites. The patient rapidly improved with doxycycline for 7 days and ceftriaxone for 11 days, then was lost to follow-up. Total DNA from blood was extracted, and amplification and sequencing with universal 16S rDNA primers D88 and E94 revealed a 100% identity with B. recurrentis A1.. LBRF is a rare but emerging infectious disease among vulnerable displaced immigrants from the Horn of Africa. Since immigrants from endemic areas can carry the vector with them, the infection should be suspected even in subjects with compatible clinical features living in the same place where new arrival immigrants are hosted. Healthcare providers should be aware of this condition to implement adequate diagnostic, therapeutic, and public health measures.

Topics: Animals; Anti-Bacterial Agents; Borrelia; Ceftriaxone; Doxycycline; Emigrants and Immigrants; Humans; Italy; Male; Meningitis, Bacterial; Pediculus; Relapsing Fever; Somalia; Young Adult

Topics: Ampicillin; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Humans; Meningitis, Bacterial

To investigate the current diagnostic and therapeutic strategies used in the care of patients with suspected bacterial meningitis at teaching hospitals in Ethiopia.. This was a hospital-based retrospective study conducted at four teaching hospitals in different regions of Ethiopia. Participants were patients aged 14 years and older treated for suspected bacterial meningitis. Presenting complaints, diagnostic strategies used and treatments given were obtained from clinical records.. A total of 425 patients were included in the study; 52.7% were men and 83.8% were younger than 50 years. Fever, headache, neck stiffness and impaired consciousness were the most common clinical presentations; 55.5% underwent lumbar puncture. Overall, only 96 (22.6%) patients had cerebrospinal fluid abnormalities compatible with bacterial meningitis. A causative bacterium was identified in only 14 cases. Ceftriaxone was used as the empiric treatment of choice, either alone or in combination with other antibiotics; 17.6% of patients were also given vancomycin. Adjunctive dexamethasone was given to 50.4%.. Most patients treated as bacterial meningitis did not receive a proper diagnostic workup. The choice of antibiotic was not tailored to the specific clinical condition of the patient. Such an approach may result in poor treatment outcomes and lead to antibiotic resistance. Management of patients with suspected bacterial meningitis should be supported by analysis of cerebrospinal fluid, and treatment should be tailored to local evidence and current evidence-based recommendations.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteria; Case Management; Ceftriaxone; Developing Countries; Dexamethasone; Drug Resistance, Microbial; Ethiopia; Female; Hospitals, Teaching; Humans; Income; Male; Meningitis, Bacterial; Middle Aged; Retrospective Studies; Spinal Puncture; Young Adult

A 38-year-old man visited our hospital because of hemifacial paresis that developed 2 months after being bit by a tick. We diagnosed idiopathic peripheral facial palsy and gave the patient oral prednisolone and valacyclovir. Although the symptoms completely resolved in about 2 weeks, there was a risk of Lyme neuroborreliosis. The patient therefore received doxycycline (100 mg twice daily) and amoxicillin (1,000 mg 3 times daily) for 14 days. Two months later, he had symptoms of meningitis such as headache and fever accompanied by lymphocytic cerebrospinal fluid pleocytosis. Viral meningitis was diagnosed and treated with parenteral acyclovir. The symptoms of meningitis improved. Tests for serum IgG antibodies against borrelia were positive. We gave the patient a diagnosis of Lyme neuroborreliosis. The patient received intravenous ceftriaxone and had no relapse. It is a rare for meningitis to develop in a patient with cranial neuropathy who received doxycycline. Lyme neuroborreliosis is a rare disease in Japan. Care should therefore be exercised in the diagnosis of Lyme neuroborreliosis and evaluation of the response to treatment.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Biomarkers; Borrelia; Borrelia Infections; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Facial Paralysis; Humans; Lyme Neuroborreliosis; Male; Meningitis, Bacterial; Treatment Outcome

S. pneumoniae is the leading cause of acute bacterial meningitis (ABM) in children. Vaccination using the 10-valent conjugate vaccine (PCV-10) was recently introduced into the National Immunization Program in Mozambique, but data on serotype coverage of this vaccine formulation are scarce. In this study, we investigated the serotype distribution and antimicrobial resistance of isolates of S. pneumoniae causing ABM in children < 5 years at the two largest hospitals in Mozambique.. Between March 2013 and March 2014, a total of 352 cerebrospinal fluid (CSF) samples were collected from eligible children, of which 119 (33.8 %) were positive for S. pneumoniae. Of these, only 50 samples met the criteria for serotyping and were subsequently serotyped using sequential multiplex PCR (SM-PCR), but 15 samples were non-typable.. The most common serotypes of S. pneumoniae were 1 (18.2 %), 5 (15.2 %), 14 (12.1 %), 9 V (12.1 %), 23 F (9.1 %), 6A (9.1 %), 4 (9.1 %) and 6B (6.1 %). Serotypes 1, 5, 9 V, 6A and 12 were mostly prevalent in Northern Mozambique, while serotypes 23 F, 4, 6B, 3 and 15B were predominant in Southern. Serotype coverage of PCV-10 and PCV-13 vaccine formulations were 81.8 % and 93.9 %, respectively. Serotypes 1, 3, 4, 6B, 14, 23 F were resistant to penicillin and sensitive to ceftriaxone.. Our findings shows that changing the current in use PCV-10 vaccine formulation to PCV-13 formulation might increase substantially the protection against invasive strains of S. pneumoniae as the PCV-10 vaccine formulation does not cover the serotypes 3 and 6A, which are prevalent in Mozambique.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Epidemiological Monitoring; Female; Humans; Immunization Programs; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Mozambique; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Polymerase Chain Reaction; Prevalence; Serotyping; Streptococcus pneumoniae

To analyze the clinical characteristics of blood stream infection caused by Streptococcus agalactiae in children and the drug-resistance of the isolates.. All cases with Streptococcus agalactiae growth in blood or cerebrospinal fluid cultures from January 1, 2011 to December 31, 2015 were enrolled by checking the laboratory information system (LIS) from 7 Class 3 Grade A hospitals (4 in Zhejiang, 2 in Shanghai and 1 in Chongqing). Clinical data were collected for analysis. χ(2) test, t test and non parametric test were used in the study.. One hundred and eighty-one pediatric cases of blood stream infection caused by Streptococcus agalactiae were included in current study. Eighty-six cases (47.5%) were male, and with age range from one day to 9 years (media 13 days). Thirty cases (16.6%) were premature infants and 127 cases (70.2%) were born via vaginal delivery. Seventy-one cases (39.2%) had early onset (<7 d) infections, and 106 cases (58.6%) had late onset (7-89 d) infections. Seventy-eight cases (43.1%) were complicated with purulent meningitis. Incidences of vaginal delivery(81.7%(58/71) vs. 62.3%(66/106)), shortness of breath moaning (43.7%(31/71) vs. 15.1%(16/106)) and preterm premature rupture of membranes (25.4%(18/71) vs. 3.8%(4/106)) were higher in the early onset infection group compared with the late onset group(P all<0.05). However, the number of cases who had fever(25.4%(18/71)vs.85.8%(91/106)) and complicated with purulent meningitis (29.6%(21/71) vs. 53.8%(57/106)) in early onset infections group was less than that in the late onset group(P both<0.05). The blood cultures of most patients (87.8%) were performed before the use of antibiotics. Drug-resistant tests showed that the sensitive rates to penicillin G, ceftriaxone and cefotaxime were 98.9%, 99.0% and 99.0% respectively. All strains were sensitive to vancomucine. The rates of resistance to clindamycin and erythromycin were 68.0% and 34.0%, respectively. Only 39 cases (22.0%) were treated with single antibiotics of either penicillins or cephalosporins, 80 cases (45.2%) were treated with antibiotics containing β lactamase inhibitor, 61 cases (34.5%) were treated with either meropenem or cefoperazone-sulbactam. One hundred and fifty-four cases were cured, while 19 died (including 13 complicated with purulent meningitis) and 8 lost to follow up after giving up of treatment.. The incidence and mortality of blood stream infection caused by Streptococcus agalactiae complicated with purulent meningitis are high in children. Penicillin is the first choice in treatment. Antibiotics should be selected accorrding to the drug-resistance test.

Topics: Anti-Bacterial Agents; Bacteremia; Cefotaxime; Ceftriaxone; Cephalosporins; Child; China; Clindamycin; Drug Resistance, Bacterial; Erythromycin; Female; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Penicillins; Retrospective Studies; Streptococcal Infections; Streptococcus agalactiae

A 61-year-old man with chronic hepatitis B and dyslipidemia visited the emergency department with a fever and severe headache. He was diagnosed with bacterial meningitis after a lumbar puncture, and blood culture revealed Parvimonas micra bacteremia. Although he had a history of extraction of a molar two weeks before symptom onset, there was no evidence of abscess formation on physical examination or imaging studies. He was successfully treated with oral metronidazole for 12 days after 9 days of treatment with IV ceftriaxone and vancomcycin. This is the first report of primary bacterial meningitis caused by this organism, which indicates that this organism is capable of being a bacterial meningitis pathogen.

Topics: Anti-Bacterial Agents; Bacteremia; Bacteria, Anaerobic; Ceftriaxone; Dyslipidemias; Firmicutes; Gram-Positive Bacterial Infections; Hepatitis B, Chronic; Humans; Male; Meningitis, Bacterial; Metronidazole; Middle Aged; Treatment Outcome; Vancomycin

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Ceftriaxone; Chile; Humans; Meningitis, Bacterial; Streptococcus pneumoniae; Treatment Failure

Non-typhoidal salmonellae are important pathogens causing bacteraemia, especially in immunocompromised patients, but there are limited data explicitly describing the clinical characteristics and outcome in these individuals. Recurrent invasive salmonellosis has been recognised as an AIDS-defining condition in HIV-positive patients since the 1980s. Salmonella meningitis is an infrequent complication of Salmonella sepsis, accounting for 0.8-6% of all cases of bacterial meningitis, and is associated with a high mortality rate.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Female; HIV Infections; Humans; Meningitis, Bacterial; Salmonella Infections

Sphingomonas paucimobilis is an aerobic gram-negative bacillus. The bacteria can cause infections, which can be devastating and, therefore, the patients need adequate and early antibiotic cover. We are presenting an interesting case of meningitis secondary to an unusual S. paucimobilis infection. This is the second case to our knowledge in the literature on meningitis due to S. paucimobilis. The 31-year-old previously healthy man presented with 2 months' history of weight loss and loss of appetite. He had fever and headache for 3 weeks. He was also speaking irrelevantly for 3 weeks. He had change of behaviour for 1 day. The patient was a farmer and worked in the soil. On examination, he was not responding to questions and was not obeying commands. Computed tomography (CT) brain with contrast revealed meningeal enhancement and cerebral oedema. Lumbar puncture was performed. Cerebrospinal fluid (CSF) opening pressure was more than 50 cm H2O. CSF analysis showed meningitis picture with raised white cell count of 210/μL (predominantly neutrophils), glucose 3.1 mmol/L, and raised protein 2.47 g/L. He was given intravenous ceftriaxone. The following day, his condition deteriorated. CSF culture grew S. paucimobilis sensitive to ceftriaxone. S. paucimobilis causes severe meningitis. This can lead to hydrocephalus, which results in a need for extraventricular drainage. A good occupational history is important with regard to finding the aetiology of serious meningitis (including rare bacteria) even before the culture result is known. Appropriate treatment can be given early and adequately to prevent mortality.

Topics: Adult; Agricultural Workers' Diseases; Anti-Bacterial Agents; Brain Edema; Ceftriaxone; Cerebrospinal Fluid; Emergencies; Fatal Outcome; Gram-Negative Bacterial Infections; Humans; Hydrocephalus; Male; Meningitis, Bacterial; Sphingomonas; Tomography, X-Ray Computed

Topics: Animals; Ceftriaxone; Dexamethasone; Drug Resistance, Multiple, Bacterial; Emergencies; Food Handling; Hearing Loss, Bilateral; Hearing Loss, Sensorineural; Humans; Labyrinthitis; Male; Meat; Meningitis, Bacterial; Middle Aged; Streptococcal Infections; Streptococcus suis; Swine

Neonatal meningitis is an important cause of morbidity in sub-Saharan Africa and requires urgent empiric treatment with parenteral administered antibiotics. Here we describe the etiology, antimicrobial susceptibility and suitability of the World Health Organization first-line recommended antibiotics (penicillin and gentamicin) for bacterial meningitis in young infants in Malawi.. We reviewed all cerebrospinal fluid samples received from infants ≤2 months of age with clinically suspected meningitis between January 1, 2002, and December 31, 2008, at the Queen Elizabeth Central Hospital in Blantyre, Malawi.. We identified 259 culture-positive isolates from 259 infants ≤2 months of age. Sixty isolates were from neonates ≤7 days old, in whom the most common pathogens were Group B Streptococcus (27/60; 45.0%), Streptococcus pneumoniae (13/60; 21.7%) and nontyphoidal Salmonella enterica (7/60; 11.7%). One hundred and ninety one isolates were from young infants who were >7 days and ≤2 months of age. In this group, the most common isolates were S. pneumoniae (80/191; 41.9%), Group B Streptococcus (38/191; 19.9%) and nontyphoidal Salmonella enterica (34/191; 17.8%). More isolates were susceptible to ceftriaxone than to the combination of penicillin and gentamicin (218/220; 99.1% vs. 202/220; 91.8%, Fisher's exact test P = 0.006). In particular, Gram-negative isolates were significantly more susceptible to ceftriaxone than to gentamicin (72/74; 97.3% vs. 63/74; 85.1%, Fisher's exact test P = 0.020). Penicillin and gentamicin provided less coverage for Gram-negative than Gram-positive isolates (74/86; 86.0% vs. 155/163; 95.1%, χ = 6.24, P = 0.012).. In view of these results, the World Health Organization recommendations for empiric penicillin and gentamicin for suspected neonatal meningitis should be reevaluated.

Topics: Anti-Bacterial Agents; Ceftriaxone; Gentamicins; Humans; Infant, Newborn; Malawi; Meningitis, Bacterial; Microbial Sensitivity Tests; Salmonella enterica; Streptococcus agalactiae; Streptococcus pneumoniae

Neonatal Escherichia coli meningitis continues to be an important cause of mortality and morbidity in newborns worldwide. The aim of this study was to investigate the cytokines/chemokines, brain-derived neurotrophic factor (BDNF) levels, blood-brain barrier integrity in neonatal rats following E. coli K1 experimental meningitis infection and subsequent behavioural parameters in adulthood. In the hippocampus, interleukin increased at 96 h, IL-6 at 12, 48 and 96 h, IL-10 at 96 h, cytokine-induced neutrophil chemoattractant-1 at 6, 12, 24, 48 and 96 h, and BDNF at 48 and 96 h. In the cerebrospinal fluid, tumour necrosis factor alpha levels increased at 6, 12, 24, 48 and 96 h. The BBB breakdown occurred at 12 h in the hippocampus, and at 6h in the cortex. We evaluated behavioural parameters in adulthood: habituation to the open-field, step-down inhibitory avoidance, object recognition, continuous multiple-trials step-down inhibitory avoidance and forced swimming tasks. In adulthood, the animals showed habituation and aversive memory impairment. The animals needed a significant increase in the number of training periods to learn and not had depressive-like symptoms.

Topics: Animals; Animals, Newborn; Anti-Bacterial Agents; Avoidance Learning; Blood-Brain Barrier; Brain-Derived Neurotrophic Factor; Ceftriaxone; Cytokines; Disease Models, Animal; Escherichia coli Infections; Gene Expression Regulation, Bacterial; Learning Disabilities; Male; Memory Disorders; Meningitis, Bacterial; Rats; Rats, Wistar; Reaction Time; Recognition, Psychology; Time Factors

Topics: Africa South of the Sahara; Age Factors; Anti-Bacterial Agents; Bacterial Vaccines; Ceftriaxone; Disease Eradication; Disease Outbreaks; Immunization Programs; Meningitis, Bacterial; Meningococcal Vaccines; Population; Population Surveillance; Species Specificity

We report a case of acute purulent meningitis caused by Streptococcus sanguinis after endoscopic ligation for oesophageal variceal haemorrhage in a cirrhotic patient without preceding symptoms of meningitis. Initial treatment with flomoxef failed. The patient was cured after 20 days of intravenous penicillin G. This uncommon infection due to S. sanguinis adds to the long list of infectious complications among patients with oesophageal variceal haemorrhage.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Esophageal and Gastric Varices; Esophagoscopy; Gastrointestinal Hemorrhage; Humans; Ligation; Liver Cirrhosis; Male; Meningitis, Bacterial; Penicillin G; Streptococcal Infections; Streptococcus sanguis

To audit the efficacy of a conservative prophylactic antibiotic policy in patients undergoing non-trauma cranial surgery.. Prospectively collected infection data in consecutive patients who underwent non-trauma cranial surgeries in one neurosurgical unit between 1 January 2003 and 31 December 2011 were reviewed. Depending on the surgery performed, a one-day course of intravenous chloramphenicol or a single dose of ceftriaxone was used as the prophylactic antibiotic therapy. Patients with clinical and CSF features suggestive of meningitis were considered to have postoperative meningitis if the CSF culture was positive.. Bacterial meningitis was diagnosed in 27 (0.8%) of 3401 patients included in the study. Multidrug-resistant (MDR, organisms that were resistant to two or more first line of antibiotics) organisms were grown from CSF in four patients with bacterial meningitis (0.1%). There were two deaths among the 27 patients with successful treatment of meningitis in the other 25 patients.. In non-trauma neurosurgical patients undergoing elective cranial procedures, a conservative prophylactic antibiotic policy is effective in achieving low rates of bacterial meningitis with low rates of MDR infections. Therefore, our results make a compelling case for a conservative prophylactic antibiotic policy.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Craniotomy; Drug Resistance, Multiple; Female; Humans; Infant; Male; Medical Audit; Meningitis, Bacterial; Middle Aged; Prospective Studies; Surgical Wound Infection; Treatment Outcome; Young Adult

Topics: Anti-Bacterial Agents; Cardiotonic Agents; Ceftriaxone; Combined Modality Therapy; Communicable Diseases, Emerging; Drug Therapy, Combination; Humans; Immunocompetence; Male; Meningitis, Bacterial; Middle Aged; Pharyngitis; Respiration, Artificial; Sepsis; Streptococcal Infections; Streptococcus agalactiae; Vancomycin

To determine the common aetiolog of acute bacterial meningitis in children and their antibiotic susceptibility pattern.. A retrospective study with a review of cerebrospinal fluid culture reports of paediatric patients aged 0-15 years, suspected of acute meningitis in the Medical Microbiology Department of Aminu Kano Teaching Hospital, Kano, Nigeria from October 2006 to October 2009 from October 2006 to October 2009.. A positive culture bacterial isolation rate of 3.3% (n=50/1500) with prevalence of Streptococcus pneumoniae (24%), Neisseria meningitidis (22%), Escherichia coli (16%), Haemophilus influenzae (14%), Group B streptococci (8%) and Enterococci (8%) which were susceptible to ceftriaxone (96%), cefotaxime (95%) and ciprofloxacin (93%) across the bacterial isolates. Neonates were 55% (n=6.8/12.4) most at risk.. Neonates are the most at risk of acute bacterial meningitis. In the absence of antibiotic susceptibility report, ceftriaxone should be considered as a first choice reliable antibiotic for empirical treatment of meningitis in children, in this environment.

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cerebrospinal Fluid; Child; Child, Preschool; Ciprofloxacin; Enterococcus; Escherichia coli; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Meningitis, Escherichia coli; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Microbial Sensitivity Tests; Nigeria; Retrospective Studies; Streptococcus agalactiae; Tertiary Care Centers

We had for aim to check the appropriateness of our practices according to French guidelines (17th consensus conference, SPILF 2008) and to identify variables associated with the delay before appropriate measures were implemented.. Our retrospective observational study (2009-2011) focused on acute bacterial meningitis (ABM) in adults. Data was collected on a standardized questionnaire from medical charts and nurse reports.. We included 31 adults presenting with ABM; 29 (93.5%) received ceftriaxone or cefotaxime in the emergency department. Indications for corticosteroids and brain imaging complied with guidelines in respectively 71.0% and 83.9% of cases. The median delays (IQR) were: admission/lumbar puncture (LP), 2h43 [1h09-5h57]; admission/antimicrobials, 3h21 [1h34-5h11]. The indication of suspected ABM in the admission letter was associated with earlier LP (P=0.01), and was almost significantly associated also with faster initiation of adequate antibiotic therapy (P=0.05).. Suspicion of ABM mentioned in the admission letter was associated to a better management in the emergency department.

Topics: Adult; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Delayed Diagnosis; Disease Management; Emergency Service, Hospital; Female; Guideline Adherence; Humans; Male; Meningitis, Bacterial; Middle Aged; Practice Guidelines as Topic; Retrospective Studies; Risk Factors; Spinal Puncture

Infection of the central nervous system by streptococci is known to result in severe bacterial meningitis, however some strains have low pathogenic potential and affect the brain only in immunocompromised patients. Here we report the first case of an otherwise healthy non immunocompromised young adult woman who developed meningitis caused by Streptococcus dysgalactiae subspecies equisimilis. The patient was in the 17th week of her 3rd pregnancy. The course of the disease was quickly remittent under antibiotic treatment.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Meningitis, Bacterial; Pregnancy; Pregnancy Complications, Infectious; RNA, Ribosomal, 16S; Streptococcal Infections; Streptococcus

Topics: Aged; Amoxicillin; Antibodies, Bacterial; Antigens, Bacterial; Bacterial Typing Techniques; Ceftriaxone; Chromatography, Affinity; Cross Reactions; Delayed Diagnosis; Drug Resistance, Bacterial; Drug Substitution; Drug Therapy, Combination; Endocarditis; Enterococcus faecalis; False Positive Reactions; Gentamicins; Humans; Male; Meningitis, Bacterial; Species Specificity; Spinal Puncture; Streptococcus pneumoniae

Topics: Adult; Animals; Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Ciprofloxacin; Female; Fusobacterium Infections; Humans; Hypoxia; Meningitis, Bacterial; Penicillanic Acid; Pets; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pneumonia, Bacterial; Rats; Respiratory Distress Syndrome; Streptobacillus; Thrombocytopenia

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Glutamic Acid; Humans; Meningitis, Bacterial; Neuroprotective Agents

Erysipelothrix rhusiopathiae is a gram-positive bacillus which is found worldwide. Although bloodstream infections caused by E. rhusiopathiae are not common, there is a strong association between bacteremia and the development of infective endocarditis. The risk of human infection with Erysipelothrix is closely related to the opportunity for exposure to the organisms. We report a case of community-acquired meningitis as an initial manifestation of E. rhusiopathiae endocarditis in a 56-year-old woman, who had no history of exposure to animals.

Topics: Acute Disease; Aged; Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Erysipelothrix; Erysipelothrix Infections; Female; Humans; Male; Meningitis, Bacterial; Middle Aged

An evaluation committee studied the relationship between initial treatment drug and prognosis in 339 of 466 subjects with bacterial meningitis treated at 108 institutions between April 2004 and January 2007, after excluding those with uncertain diagnosis or non-assessable records. Prognosis was considered unfavorable if meningitis sequelae such as quadriplegia, deafness, or epilepsy were present in 3- month follow-up; Based on this definition, 43 (12.7%) had a poor prognosis. No significant relationship was seen between unfavorable prognosis and age or causative pathogen. More had an unfavorable prognosis if treatment was initiated 4 days or later after onset. The percentage with an unfavorable prognosis was 6.4% (4/64) in the group administered combined panipenem/betamipron (PAPM/BP) plus ceftriaxone (CTRX), 10.5% (6/57) administered MEPM plus cefotaxime (CTX), 14.0% (7/50) administered meropenem (MEPM) plus CTRX, and none of the 23 administered CTRX alone. The percentage with an unfavorable prognosis was 26.2% (11/42) in those administered MEPM, significantly higher than that in those administered PAPM/BP plus CTRX, MEPM plus CTX, or CTRX alone (p < 0.05). We concluded that in initial treatment, it would be more desirable to use MEPM combined with another drug than alone.

Topics: Anti-Bacterial Agents; beta-Alanine; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Therapy, Combination; Humans; Infant; Meningitis, Bacterial; Meropenem; Prognosis; Thienamycins

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Humans; Infant; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Pneumococcal; Neisseria meningitidis; Treatment Outcome

Bilateral, spontaneous cerebrospinal fluid rhinorrhoea is extremely rare, with only one previous case report (this patient developed contralateral cerebrospinal fluid leakage four years after successful endoscopic repair). We present the first English-language report of simultaneous, bilateral, spontaneous cerebrospinal fluid rhinorrhoea.. To recommend a simple alternative endoscopic technique for simultaneous closure of bilateral, spontaneous cerebrospinal fluid rhinorrhoea.. A 47-year-old woman presented with recent onset of bilateral, spontaneous cerebrospinal fluid rhinorrhoea, a recent history suggestive of meningitis, and a past history of pneumococcal meningitis. Bony defects on both sides of the cribriform plate were closed endoscopically in the same anaesthetic session, via a uninasal, trans-septal approach, enabling both leakage sites to be sealed simultaneously.. In cases of bilateral, spontaneous cerebrospinal fluid rhinorrhoea, uninasal, trans-septal endoscopic repair is a simple and effective technique for simultaneous closure of cerebrospinal fluid leakage.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cerebrospinal Fluid Rhinorrhea; Endoscopy; Ethmoid Bone; Female; Fistula; Humans; Magnetic Resonance Imaging; Meningitis, Bacterial; Middle Aged; Minimally Invasive Surgical Procedures; Nasal Cavity; Nasal Surgical Procedures; Postoperative Care; Rare Diseases; Tomography, X-Ray Computed; Treatment Outcome

Topics: Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Male; Meningitis, Bacterial

Topics: Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Male; Meningitis, Bacterial

Topics: Adrenal Cortex Hormones; Adult; Analgesics; Anti-Bacterial Agents; Back Pain; Bacteremia; Bacterial Toxins; Ceftriaxone; Dominican Republic; Drug Therapy, Combination; Emergencies; Exotoxins; Headache; Humans; Leukocidins; Male; Meningitis, Bacterial; Methicillin-Resistant Staphylococcus aureus; Spain; Staphylococcal Infections; Vancomycin

The aim of this study was to compare the efficacy of ceftriaxone plus vancomycin (Vancoplus) versus ceftriaxone alone against cephalosporin resistant methicillin-resistant Staphylococcus aureus (MRSA) strain by using meningitis mice model. The MRSA strain ATCC 43300 was used to induce meningitis in mice. The mice were fed standard pelleted diet and water ad libitum. The test room was air conditioned with temperature 23 +/- 2 degrees C, humidity 65+/- 5% and with artificial fluorescent light 10-14 hrs. of light and dark, respectively. Twenty four mice were divided into four group containing six rats in each group. The ceftriaxone group received 28.57 mg/Kg body weight/day and the vancoplus group received 42.8 mg/Kg body weight/day and control as well as infected group received normal saline. The bacterial susceptibility test in CSF was performed for cephalosporin resistance MRSA strain by determining the lytic zone for the vancoplus and ceftriaxone antibiotic. The lytic zone was more in vancoplus as compared to ceftriaxone. It was also found that activities of antioxidant enzymes such as catalase were significantly increased (p<0.001) along with decreased (p<0.001) in lipid peroxidation (malonaldialdehyde) level in CSF of vancoplus treated group as compared to infected as well as ceftriaxone resistance group and come back to normal level. It was concluded that vancoplus beneficial for the patients who suffered from cephalosporin resistant MRSA bacterial strain.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Cephalosporin Resistance; Malondialdehyde; Meningitis, Bacterial; Methicillin-Resistant Staphylococcus aureus; Mice; Microbial Sensitivity Tests; Models, Animal; Rats; Staphylococcal Infections; Vancomycin

Bacterial meningitis is associated with intense inflammation and also linked to the production of reactive oxygen species. To this aim, animals underwent a magna cistern tap and received either sterile saline as a placebo or an equivalent volume of a Streptococcus pneumoniae suspension. The animals began antibiotic therapy 16h after induction. The animals were sacrificed at 24 or 48h post-infection and the hippocampus and cortex were harvested. The activity of the enzymes superoxide dismutase, catalase, and thiobarbituric acid reactive species, protein carbonyls, and free sulphydryl groups were altered, but reversed, in part, by the antibiotic treatment. Our results support the hypothesis that antibiotic treatment prevents, in part, the oxidative stress in the bacterial meningitis induced by Streptococcus pneumoniae.

Topics: Animals; Anti-Bacterial Agents; Brain; Ceftriaxone; Cerebral Cortex; Hippocampus; Male; Meningitis, Bacterial; Oxidative Stress; Rats; Rats, Wistar; Streptococcal Infections; Streptococcus pneumoniae

To evaluate the penetration of ceftriaxone into the cerebrospinal fluid (CSF) in patients with invasive bacterial infection and to define correlation between the penetration and laboratory markers of inflammation.. Levels of ceftriaxone in the serum and CSF of 17 patients with purulent meningitis were examined. Serum concentrations of ceftriaxone before and after its administration were measured in 9 patients (18 samples, 52.9 %) by microbiological assay based on the agar diffusion test. In all patients, the CSF/serum quotient for ceftriaxone was calculated and correlated with laboratory markers of inflammation (C-reactive protein, fibrinogen and neutrophils). The CSF from nine patients with positive culture for bacteria was used for a modified bactericidal test.. Ceftriaxone levels in the serum before and after administration (31.2 mg/l -/+ SD 12.29 and 300.0 mg/l -/+ SD 125.9, respectively) were different (p = 0.000156). The decrease of ceftriaxone levels in the CSF was gradual. There was also a significant difference between the levels of inflammatory markers and CSF/serum quotient of ceftriaxone. Patients with the values higher than 0.1 had higher CRP serum levels (p = 0.00192), fibrinogen serum levels (p = 0.0178) as well as neutrophil count in the CSF (p = 0.0112). However, no inflammatory markers (or their combinations) predicted the extent of penetration of ceftriaxone into the CSF.. High serum concentration of ceftriaxone causes higher penetration through the inflamed blood-brain barrier. Higher antibiotic penetration correlated with the extent of systemic inflammatory response. However, no inflammatory marker predicted the rate of ceftriaxone crossing the blood-brain barrier. Ceftriaxone penetration, with a 24-hour regimen of administration, remains reliable and efficient therapy of purulent meningitis.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Female; Fibrinogen; Humans; Inflammation; Interleukin-6; Male; Meningitis, Bacterial; Middle Aged; Young Adult

Topics: Adult; Algorithms; Ampicillin; Ceftriaxone; Child; Community-Acquired Infections; Dexamethasone; Diagnosis, Differential; Drug Therapy, Combination; Emergencies; Humans; Meningitis, Bacterial; Meningitis, Listeria; Meningitis, Meningococcal; Meningitis, Pneumococcal; Neurologic Examination

Topics: Anti-Bacterial Agents; Brain; Ceftriaxone; Cerebrospinal Fluid Otorrhea; Diagnosis, Differential; Follow-Up Studies; Headache; Humans; Male; Meningitis, Bacterial; Recurrence; Spinal Puncture; Tomography, X-Ray Computed; Young Adult

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Cholelithiasis; Community-Acquired Infections; Female; Humans; Infant; Infusions, Intravenous; Injections, Intravenous; Male; Meningitis, Bacterial; Pneumonia, Bacterial; Urinary Tract Infections

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Borrelia burgdorferi; Ceftriaxone; Humans; Immunoglobulin M; Lyme Disease; Lyme Neuroborreliosis; Male; Meningitis, Bacterial; Ocular Motility Disorders; Spinal Cord

Topics: Aminoglycosides; Anti-Bacterial Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Blood Cell Count; Bone Marrow; Ceftriaxone; Child; Chromosomes, Human, Pair 10; Cytarabine; Daunorubicin; Diagnosis, Differential; Escherichia coli Infections; Etoposide; Flow Cytometry; Gemtuzumab; Humans; Injections, Spinal; Leukemia, Myeloid, Acute; Male; Meningitis, Bacterial; Patient Transfer; Spinal Puncture; Trisomy

We report a case of a 9-month-old baby admitted to the hospital because of low-grade fever, focal seizures in a context of watery diarrhea for 14 days' duration. The patient workup revealed a mild neutrophilic pleocytosis on cerebrospinal fluid (46 cells/microl), a positive stool culture for Salmonella pomona sensitive to ceftriaxone and ciprofloxacin, and a subdural empyema (SDE) on the cerebral MRI. The child received an intravenous third-generation cephalosporin for 4 weeks which resulted in cure. This case highlights an unusual extra-intestinal complication of non-typhoid salmonella infection. Involvement of the central nervous system with non-typhoidal salmonellosis is an important complication that can result in significant morbidity if not recognized and treated promptly. A focal intra-cranial infection must be considered in the differential diagnosis of any child presenting with focal seizures and gastroenteritis due to Salmonella. Appropriate diagnostic imaging of the head (cerebral CT scan with contrast and/or MRI) is mandatory to exclude the presence of an intra-cranial complication, even in the presence of negative CSF culture for Salmonella. Subfrontal and subtemporal SDE are sometimes missed on axial CT scans and better appreciated on MRI. Non-surgical treatment of small subdural empyemas with prolonged intravenous antibiotic therapy is a therapeutic option.

Topics: Anti-Bacterial Agents; Ceftriaxone; Empyema, Subdural; Female; Humans; Infant; Meningitis, Bacterial; Salmonella Infections

Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum. A chancre usually develops initially. Organ involvement and neurological complications may occur, sometimes several years after the initial exposure. We managed two patients with syphilis responsible for joint or neurological manifestations, diagnosed in 2008. One patient presented with oligoarthritis involving the knees and right elbow, coinciding with a maculopapular and pustular eruption. In the other patient, meningoradiculitis involving the T8, T9, and T10 metameres prompted a test for Lyme disease, which was weakly positive, leading to evaluation for false-positivity due to a cross-reaction. Neither patient was infected with the HIV.

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Diagnosis, Differential; Elbow Joint; Humans; Knee Joint; Lyme Neuroborreliosis; Male; Meningitis, Bacterial; Middle Aged; Neurosyphilis; Penicillin G Benzathine; Skin Diseases, Papulosquamous; Syphilis Serodiagnosis; Syphilis, Cutaneous; Treatment Outcome; Treponema pallidum

Hidradenitis suppurativa (HS), which is characterized by the obstruction of the apocrine gland channels and development of secondary bacterial infections, is a rare clinical entity mostly seen in women. In this case report, a bacterial meningitis case, which emerged after HS in the gluteal region, was presented. To the authors' knowledge this is the first case in the literature. Sixty-years-old male patient was admitted to the infectious disease department with high fever, lack of consciousness and orientation and cooperation problems. Upon detection of neck stiffness during physical examination, cerebrospinal fluid (CSF) specimen was taken. CSF analysis revealed increased pressure, turbidity, (++++) Pandy reaction and 33.600/ml leucocytes (95% PMNL). CSF glucose was 2 mg/dl (simultaneous blood glucose was 156 mg/dl) and protein was 360 mg/dl. Gram stained smear of the CSF specimen yielded high numbers of gram-positive cocci. Empirical treatment with intravenous ceftriaxone (2 x 2 g/day) and linezolid (2 x 600 mg/day) was initiated upon the diagnosis of acute bacterial meningitis. Physical examination of the patient revealed HS characterized by common fistulas in gluteal area and drainage from the fistula with drainage in left gluteal area. White blood cell blood count was 26.700/mg, platelet count was 501.000/ml and hemoglobin was 14.8 mg/dl. Erythrocyte sedimentation rate was 120 mm/hour. In the magnetic resonance imaging of the vertebra, fistula tract was determined between inflammed tissue and sacral subarachnoid region. Since the culture of CSF and blood did not yield any growth, the probable causative agent was thought to be an anaerobic gram-positive coccus. The treatment continued for 21 days for ceftriaxone and 28 days for linezolid. The patient was successfully treated and was transferred to neurosurgery department without any sequela for the management of fistulas.

Topics: Acetamides; Anti-Bacterial Agents; Anti-Infective Agents; Buttocks; Ceftriaxone; Cerebrospinal Fluid; Gram-Positive Cocci; Hidradenitis Suppurativa; Humans; Linezolid; Male; Meningitis, Bacterial; Middle Aged; Oxazolidinones

We examined the cerebrospinal fluid penetration of daptomycin after the addition of dexamethasone and its bactericidal efficacy with and without ceftriaxone in an experimental rabbit model of pneumococcal meningitis. The combination of daptomycin with ceftriaxone was the most efficacious regimen for pneumococcal meningitis. The previous addition of dexamethasone affected the antibacterial activity of daptomycin only marginally, either as monotherapy or combined with ceftriaxone, although the penetration of daptomycin into inflamed meninges was significantly reduced from 6 to 2%. Daptomycin with ceftriaxone might be a potential candidate for the empirical therapy of bacterial meningitis, although the activity of this regimen against Listeria monocytogenes remains to be demonstrated.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Chromatography, High Pressure Liquid; Daptomycin; Dexamethasone; Drug Therapy, Combination; Meningitis, Bacterial; Rabbits; Vancomycin

Sinusitis can rarely be latent and present directly with intracranial complications. We present the case of an 11-year-old girl who presented with typical features of meningitis. She underwent neuroimaging because of slow improvement and concern for a brain abscess. Despite no history or examination findings suggestive of sinusitis, she was found to have pansinusitis with intracranial extension causing meningitis and epidural abscess.

Topics: Bacteroidaceae Infections; Cefotaxime; Ceftriaxone; Child; Combined Modality Therapy; Consciousness Disorders; Diagnostic Imaging; Drug Therapy, Combination; Eikenella; Emergencies; Endoscopy; Epidural Abscess; Female; Fusobacterium Infections; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Meningitis, Bacterial; Metronidazole; Otorhinolaryngologic Surgical Procedures; Peptostreptococcus; Prevotella intermedia; Sinusitis; Staphylococcal Infections; Vancomycin

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Clinical Trials as Topic; Codes of Ethics; Drug Industry; Ethics, Research; Fluoroquinolones; Helsinki Declaration; Humans; Informed Consent; Internationality; Meningitis, Bacterial; Nigeria; United States

We carried out a prospective observational study on clinical features of bacterial meningitis. Between October 2002 and June 2005, 322 adult bacterial meningitis cases in 49 infectious disease wards in Italy (MENTORE study group) were enrolled in the study. 133 cases were due to Streptococcus pneumoniae, 44 to Neisseria meningitidis and 145 to other microorganisms. A high SAPS score and coma on admission, as well as need for mechanical ventilation, were more frequent in the pneumococcal meningitis group. Neurological impairment was present in 151 out of 311 patients, and was more frequent in pneumococcal meningitis. A single antibiotic was employed in only 90 of 315 cases; a combination of ceftriaxone and ampicillin was the most frequently administered treatment. Ceftriaxone was also the single most used drug. Adjunctive treatment with steroids was administered in 210 out of 303 patients for a median duration of 7 days. Median duration of fever was 4 days, and median hospital stay was 16 days; hospitalization was significantly longer in the pneumococcal meningitis group. At discharge, neurological impairment was still present in 59 (21%) of 277 patients. Twenty (6.9%) out of 289 patients died during hospitalization. Distribution of adverse outcome (death and neurological impairment) in patients treated with or without steroids and within different time zones between onset of symptoms and commencement of antibiotics was studied; a trend toward a worse prognosis was seen in patients treated more than 24 hours after onset of the disease.In our study, infectious disease clinicians made extensive use of steroids as adjuvant therapy for bacterial meningitis, even in absence of detailed national and local guidelines. Mortality seemed to be lower in comparison with the literature.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Italy; Length of Stay; Male; Meningitis, Bacterial; Middle Aged; Neisseria meningitidis; Prospective Studies; Respiration, Artificial; Severity of Illness Index; Streptococcus pneumoniae; Time Factors; Young Adult

* Young infants who have meningitis may present with nonspecific clinical manifestations. * S. pneumoniae and N. meningitidis remain the most common causes of bacterial meningitis in the infant and child, and GBS continues to be the most common neonatal pathogen. * Empiric therapy for suspected bacterial meningitis in a non-neonate includes a combination of parenteral vancomycin and either cefotaxime or ceftriaxone. * Children whose GCS scores are less than 8, show signs of shock or respiratory compromise, and have focal neurologic findings or clinical signs of elevated intracranial pressure should be admitted to a pediatric intensive care unit. * Sensorineural hearing loss occurs in 30% of children who have pneumococcal and 10% of those who have meningococcal meningitis.

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Drug Therapy, Combination; Hearing Loss; Humans; Incidence; Infant; Intracranial Hypertension; Meningitis; Meningitis, Bacterial; Meningitis, Meningococcal; Vancomycin

Acinetobacter baumannii is a prolific nosocomial pathogen renowned for its multidrug-resistant nature. We report a case of community-acquired meningitis due to A. baumannii. The case highlights the potential pathogenicity of this organism and raises concerns that this highly adaptable organism may soon evolve into a significant community pathogen, too.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Anti-Bacterial Agents; Anti-Inflammatory Agents; Ceftriaxone; Community-Acquired Infections; Cross Infection; Dexamethasone; Humans; Male; Meningitis, Bacterial; Meropenem; Middle Aged; Thienamycins

Early adjuvant dexamethasone treatment has been internationally recommended for adults with bacterial meningitis (BM) since 2002. We explored the local recommendations in Denmark concerning treatment with dexamethasone and antibiotics for BM.. A questionnaire was sent to all Danish departments of infectious diseases, paediatrics and internal medicine (n = 92) concerning their local treatment recommendations for BM in the period 2002-2004.. The overall response rate was 79%: 100%, 100% and 72%, respectively, for the three departmental types. Early treatment of BM with dexamethasone was recommended in 5 of 5 (100%) departments of infectious diseases, in 13 of 17 (76%) departments of paediatrics and in 22 of 35 (63%) departments of internal medicine. Four, five, and nine different empirical antibiotic regimens were recommended in the departments of infectious diseases, paediatrics, and internal medicine, respectively. In this three-year period, six departments changed their empirical antibiotic regimen: three to a broader-spectrum regimen and three to a regimen with unchanged bacteriological coverage.. A considerable number of departments of internal medicine (37%) did not include early dexamethasone treatment in their recommendations for BM, despite the international consensus to provide this adjunctive treatment when pneumococcal meningitis is suspected. In addition, a great variation in the recommended empirical antibiotic treatment was demonstrated in this geographically small area.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Chemotherapy, Adjuvant; Child, Preschool; Denmark; Gentamicins; Glucocorticoids; Humans; Meningitis, Bacterial; Penicillins; Practice Guidelines as Topic; Practice Patterns, Physicians'; Surveys and Questionnaires

Topics: Adult; Agricultural Workers' Diseases; Bacteremia; Ceftriaxone; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Sinusitis; Streptococcal Infections; Streptococcus equi; Tomography, X-Ray Computed; Virulence

In the African meningitis belt, reported case-fatality ratio (CFR) for meningitis are usually calculated on the basis of presumed cases. We reviewed 3509 presumed cases of bacterial meningitis reported in Niger for which a cerebrospinal fluid (CSF) sample had been tested later at the reference laboratory. The main aetiologies were Neisseria meningitidis (1496 cases), Streptococcus pneumoniae (303 cases) and Haemophilus influenzae (105 cases). The CFR of meningococcal meningitis was lower for serogroup A (5.5%) than for serogroups X (12%) and W135 (12.7%). With a CFR of 49.8%, pneumococcal meningitis, albeit representing only 20.7% of confirmed cases, accounted for 50% of the deaths. The disease burden of pneumococcal meningitis must be better taken into consideration in the future. As most treatments are presumptive, there is a urgent need for an easy-to-administer, cheap first-line treatment effective on N. meningitidis as well as on S. pneumoniae and H. influenzae that would replace the single-dose oily chloramphenicol treatment which is the most frequent treatment administered today, independent of microbial aetiology and season. The development of diagnostic tools really suitable for remote health facilities also is an urgent challenge.

Topics: Adolescent; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Neisseria meningitidis; Niger; Streptococcus pneumoniae; Survival Rate

Review of 497 cases of neuroinfections in 7 tropical clinics in Ethiopia, Uganda, Burundi, Kenya, Sudan within 2000-2007 was performed. 97.5% of all cases was cerebral malaria (40.1%) and bacterial meningitis (56.4%). TB meningitis, cerebral cryptococcosis and sleeping sickness were very rare.

Topics: Africa South of the Sahara; Anti-Bacterial Agents; Antimalarials; Artemether; Artemisinins; Ceftriaxone; Chloramphenicol; Diagnosis, Differential; Drug Therapy, Combination; Humans; Laboratories; Malaria, Cerebral; Medically Underserved Area; Meningitis, Bacterial; Quinine; Retrospective Studies; Tropical Medicine

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Ceftriaxone; Dexamethasone; Floxacillin; Gentamicins; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Methylprednisolone; Rifampin; Staphylococcal Infections; Vasculitis

Topics: Adolescent; Adult; Anti-Bacterial Agents; Ceftriaxone; Dexamethasone; Drug Therapy, Combination; Glucocorticoids; Humans; Meningitis, Bacterial; Treatment Outcome

Topics: Anti-Bacterial Agents; Base Sequence; Capnocytophaga; Ceftriaxone; Gram-Negative Bacterial Infections; Humans; Male; Meningitis, Bacterial; Middle Aged; Molecular Sequence Data; Polymerase Chain Reaction; RNA, Ribosomal, 16S

Streptococcus equi subspecies equi is involved in human infection. We present a case of meningitis in a 75-year-old patient with a favorable outcome after ceftriaxone and dexamethasone therapy. To our knowledge, it is the first case reported in an adult.

Topics: Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents; Ceftriaxone; Dexamethasone; Drug Therapy, Combination; Fatal Outcome; Female; Follow-Up Studies; Humans; Meningitis, Bacterial; Streptococcal Infections; Streptococcus equi

Salmonella panama is group-D nontyphi salmonella strongly associated with invasive infection, including meningitis. So far, no case of S. panama meningitis has been reported from the United States, and none has ever been reported in babies >3.5 months of age. To the best of our knowledge, we are reporting the first such case in English-language literature.

Topics: Anti-Bacterial Agents; Ceftriaxone; Humans; Infant; Male; Meningitis, Bacterial; Salmonella; Salmonella Infections; Seizures

In 2003, the reported gonorrhea rate among women was 118.8 per 100,000 women. Most gonococcal infections in pregnant women are asymptomatic or produce a mildly symptomatic genital infection. Disseminated infections can occur when gonococcal bacteremia produces extragenital symptoms, most commonly arthritis.. A patient presented in the third trimester of pregnancy with fever, body aches, neck soreness, and skin lesions. There was no arthritis. Cultures performed during evaluation confirmed extragenital Neisseria gonorrhoeae.. A high index of suspicion is necessary to diagnose disseminated gonococcal infection and prevent disease sequelae.

Topics: Adult; Bacteremia; Ceftriaxone; Dermatitis; Female; Fever; Gonorrhea; Humans; Meningitis, Bacterial; Neisseria gonorrhoeae; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome

We report a case of a 24-year-old immigrant from Bangladesh with Salmonella typhi meningitis, a rare disease in the United States, especially among adults. The common manifestations of meningitis such as neck rigidity and changes in mental status did not develop and Kernig sign was absent. The patient was successfully treated with intravenous ceftriaxone. This case demonstrates the importance of considering endemic infections in the country of origin when recent immigrants and returnees to the United States present with febrile illness.

Topics: Adult; Aircraft; Bangladesh; Ceftriaxone; Emigration and Immigration; Humans; Male; Meningitis, Bacterial; Salmonella Infections; Salmonella typhi; Travel; United States

Salmonella species may cause wide spectrum of infections changing from enterocolitis to sepsis. However, Salmonella meningitis in adults is a rare but important clinical condition with a high mortality rate. In this report, a 71 years old male patient with Salmonella enteritidis meningitis who was followed-up with the diagnosis of immune thrombocytopenic purpura and had been administered azothioprin and prednisolone, has been presented and similar cases in the literature have been reviewed. The cerebrospinal fluid culture yielded S. enteritidis, and the isolate was intermediate susceptible to ampicillin, susceptible to cefotaxime, trimethoprim-sulphametoxasole, ciprofloxacin and chloramphenicol. Our patient was successfully treated with ceftriaxone (2 x 2 gr i.v.) and discharged with total cure.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Cerebrospinal Fluid; Humans; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Salmonella enteritidis; Salmonella Infections; Treatment Outcome

Topics: Analgesia, Epidural; Anti-Bacterial Agents; Back Pain; Carcinoma, Renal Cell; Ceftriaxone; Fatal Outcome; Humans; Kidney Neoplasms; Male; Meningitis, Bacterial; Middle Aged; Palliative Care; Paraplegia; Urinary Retention

Episodes of adult bacterial meningitis (ABM) at a Danish hospital in 1991-2000 were identified from the databases of the Department of Clinical Microbiology, and compared with data from the Danish National Patient Register and the Danish National Notification System. Reduced penicillin susceptibility occurred in 21 (23%) of 92 cases of known aetiology, compared to an estimated 6% in nationally notified cases (p < 0.001). Ceftriaxone plus penicillin as empirical treatment was appropriate in 97% of ABM cases in the study population, and in 99.6% of nationally notified cases. The notification rate was 75% for penicillin-susceptible episodes, and 24% for penicillin-non-susceptible episodes (p < 0.001). Cases involving staphylococci, Pseudomonas spp. and Enterobacteriaceae were under-reported. Among 51 ABM cases with no identified risk factors, nine of 11 cases with penicillin-non-susceptible bacteria were community-acquired. Severe sequelae correlated independently with age, penicillin non-susceptibility, mechanical ventilation and non-transferral to a tertiary hospital (p < 0.05; logistic regression). Other factors that correlated with severe sequelae by univariate analysis only were inappropriate clinical handling, abnormal consciousness, convulsions and nosocomial infection. Overall, the data indicated that neither age alone, community-acquired infection nor absence of identified risk factors can predict susceptibility to penicillin accurately. Recommendations for empirical antibiotic treatment for ABM should not be based exclusively on clinical notification systems with possible unbalanced under-reporting.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteria; Ceftriaxone; Female; Humans; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Middle Aged; Penicillin Resistance; Penicillins; Prognosis; Risk Factors

Pseudomonas stutzeri is a saprophytic microorganism that rarely causes severe infections. In this report, a 28 days old male patient with meningomyelocele at birth was presented. The patient was admitted to the hospital with fever, and diagnosed as meningitis on the basis of physical examination and leukocytosis (blood: 16.380/mm3, cerebrospinal fluid (CSF): 130/mm3; 90% PMNL). Following diagnosis ceftriaxone therapy was started led to improvement in clinical and laboratory findings. However on the 20th day, the clinical signs and symptoms became worse, and the patient was diagnosed to develop a second meningitis attack by laboratory examination of CSF. P. stutzeri was isolated from the CSF culture, and the isolate was found to be resistant to ceftriaxone. Upon this result the therapy has changed to meropenem. On the 5th day of the therapy, the patient has slightly improved and he was discharged due to the wishes of his parents, however he died two days after discharge. This first case of P. stutzeri meningitis in neonates was presented to withdraw attention to this clinical entity.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cerebrospinal Fluid; Drug Resistance, Bacterial; Fatal Outcome; Humans; Infant, Newborn; Male; Meningitis, Bacterial; Meningomyelocele; Meropenem; Pseudomonas Infections; Pseudomonas stutzeri; Recurrence; Thienamycins; Treatment Failure

Topics: Adult; Algorithms; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Humans; Meningitis, Bacterial; Practice Guidelines as Topic

To determine in children with meningitis whether there is any difference in mortality and neurological sequelae using chloramphenicol as first line treatment, with a change to ceftriaxone if chloramphenicol resistance is shown in vitro, compared to using ceftriaxone as first line treatment, with a change to chloramphenicol if there is no evidence of in vitro resistance.. An observational study with a retrospective control group nested within a randomised trial of fluid management for bacterial meningitis where clinical care was standardised. Chloramphenicol is standard treatment for bacterial meningitis in Papua New Guinea. In the first 150 cases we used chloramphenicol and only changed treatment to ceftriaxone if chloramphenicol resistance for cerebrospinal fluid isolates was proved. After finding 20% of Haemophilus influenzae were resistant to chloramphenicol, and that most affected children had poor outcomes, we changed to an alternative strategy. In the next 196 cases first line treatment was ceftriaxone and treatment was changed to chloramphenicol if the isolated bacteria were found to be susceptible.. When chloramphenicol was used as first line treatment for meningitis followed by ceftriaxone when in vitro resistance was shown, there was invariably a very poor outcome in chloramphenicol resistant disease (71% of children died or had severe neurological complications). Using ceftriaxone as first line treatment was effective in reducing mortality and neurological sequelae from chloramphenicol resistant Haemophilus influenzae type (71% v 9%, relative risk 0.13; 95% CI 0.02 to 0.87; p = 0.013). Changing to chloramphenicol if there was no evidence of in vitro resistance was less than half the cost of empirical use of ceftriaxone for a full course for all children with meningitis.. Using a third generation cephalosporin as first line treatment is effective in dealing with the problem of poor outcomes from meningitis due to Haemophilus influenzae that is resistant to chloramphenicol, and a strategy of changing to chloramphenicol if in vitro susceptibility is shown will reduce the use of expensive third generation cephalosporins without comprising on clinical outcomes. This highlights the urgent need to reduce the costs of third generation cephalosporins, to improve bacteriological services in developing countries, and to introduce effective and affordable vaccines against H influenzae and Streptococcus pneumoniae.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Developing Countries; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Humans; Infant; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Papua New Guinea; Retrospective Studies; Survival Analysis; Treatment Outcome

Topics: Adolescent; Bacteroidaceae Infections; Ceftriaxone; Cerebrospinal Fluid Otorrhea; Craniocerebral Trauma; Drug Therapy, Combination; Follow-Up Studies; Humans; Male; Meningitis, Bacterial; Metronidazole; Prevotella intermedia; Risk Assessment; Severity of Illness Index; Skull Fractures; Treatment Outcome

Two major outbreaks of meningitis due Neisseria meningitidis serogroup A occurred in Senegal in 1998 and 1999. The purpose of this report is to describe clinical, bacteriological and therapeutic findings in 70 patients admitted for cerebrospinal meningitis to the Infectious Disease Clinic at the Fann University Teaching Hospital in Dakar in 1999. Diagnosis was based on direct microscopic examination after Gram staining in 71% of the cases, culture in 76%, and detection of soluble antigens in cerebrospinal fluid in 24%. Median patient age was 20 years. The highest incidence, i.e. 66% of cases, was recorded during February, March and April. Meningitic syndrome and fever were observed with 86% of the cases. The average duration of antibiotic therapy was 8 days. Chloramphenicol was the most commonly used drug (84% of cases). All strains identified in cultures were sensitive to chloramphenicol, ceftriaxone and cefotaxime but resistant to cotrimoxazole. Outcome was favorable in 93% of the cases. Three patients (4%) died and two (3%) developed hearing loss. Despite the low death rate in this series of patients treated in a hospital setting, mass vaccination is still the most effective mean of controlling meningococcal meningitis.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Female; Haemophilus influenzae; Humans; Infant; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Middle Aged; Neisseria meningitidis; Senegal; Streptococcus pneumoniae; Survival Rate

Toll-like receptor-2 (TLR2) mediates host responses to gram-positive bacterial wall components. TLR2 function was investigated in a murine Streptococcus pneumoniae meningitis model in wild-type (wt) and TLR2-deficient (TLR2(-/-)) mice. TLR2(-/-) mice showed earlier time of death than wt mice (P<.02). Plasma interleukin-6 levels and bacterial numbers in blood and peripheral organs were similar for both strains. With ceftriaxone therapy, none of the wt but 27% of the TLR2(-/-) mice died (P<.04). Beyond 3 hours after infection, TLR2(-/-) mice had higher bacterial loads in brain than did wt mice, as assessed with luciferase-tagged S. pneumoniae by means of a Xenogen-CCD (charge-coupled device) camera. After 24 h, tumor necrosis factor activity was higher in cerebrospinal fluid of TLR2(-/-) than wt mice (P<.05) and was related to increased blood-brain barrier permeability (Evans blue staining, P<.02). In conclusion, the lack of TLR2 was associated with earlier death from meningitis, which was not due to sepsis but to reduced brain bacterial clearing, followed by increased intrathecal inflammation.

Topics: Animals; Ceftriaxone; Cephalosporins; Disease Models, Animal; Disease Susceptibility; Drosophila Proteins; Inflammation; Listeria monocytogenes; Listeriosis; Membrane Glycoproteins; Meningitis, Bacterial; Mice; Mice, Inbred C57BL; Mice, Knockout; Pneumococcal Infections; Receptors, Cell Surface; Streptococcus pneumoniae; Time Factors; Toll-Like Receptor 2; Toll-Like Receptors

We report on a case of a postneurosurgical meningitis due to ceftriaxone-susceptible Proteus penneri, with selection of a ceftriaxone-resistant isolate following treatment with ceftriaxone. The isolates presented identical patterns by pulsed-field gel electrophoresis and produced a single beta-lactamase named HugA with an isoelectric point of 6.7. The ceftriaxone-resistant isolate hyperproduced the beta-lactamase (increase in the level of production, about 90-fold). The sequences of the hugA beta-lactamase gene and its regulator, hugR, were identical in both P. penneri strains and had 85.96% homology with those of Proteus vulgaris. The HugA beta-lactamase belongs to molecular class A, and the transcriptional regulator HugR belongs to the LysR family.

Topics: Adult; Amino Acid Sequence; Base Sequence; beta-Lactamases; Ceftriaxone; Chromosomes, Bacterial; DNA, Bacterial; Drug Resistance; Humans; Meningitis, Bacterial; Molecular Sequence Data; Postoperative Complications; Proteus

Kingella kingae is the second most frequent germ involved in arthritis affecting young children. This germ isolation on ordinary environment is difficult, which may explain why it is seldom known. It is now widely accepted that a direct inoculate of articular and osseous samples on liquid substrate improves the culture sensitivity. Other septic localizations have been described such as endocarditis or, less commonly, meningitis.. We report the observation of a five-year-old child, treated for meningitis, with CSF culture showing evidence of scarce colonies of Kingella kingae.. By analogy with arthritis, Kingella kingae may regularly be undetected, not being isolated, in some cases of non-documented meningitis with a cerebrospinal fluid (CSF) cytology recalling a bacterial origin. It would be of interest to verify if the seeding of CSF in liquid substrate would increase the sensitiveness of the cultures.

Topics: Ceftriaxone; Cephalosporins; Cerebrospinal Fluid; Child, Preschool; Follow-Up Studies; Gentamicins; Humans; Kingella kingae; Male; Meningitis, Bacterial; Neisseriaceae Infections; Netilmicin; Time Factors

We report the case of a 51-year-old man with an allergy to amoxicillin/acid clavulanique who presented with Streptococcus pneumoniae meningitis. Initial treatment consisted of an association of antibiotics including ceftriaxone. Six days after treatment was initiated the patient developed skin reaction and the diagnosis of allergy to ceftriaxone was established by the dosage of specific IgE. Typically Streptococcus pneumoniae meningitis is treated with vancomycin and a third-generation cephalosporin. This association had to be modified because cross allergy to cephalosporins could have developed in this patient who had previously reacted to penicillins.

Topics: Ceftriaxone; Cephalosporins; Humans; Male; Meningitis, Bacterial; Middle Aged; Pneumonia, Pneumococcal; Streptococcus pneumoniae

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: Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Family Practice; Humans; Meningitis, Bacterial; Netherlands; Practice Guidelines as Topic

Despite the lack of evidence defining a time interval during which cerebrospinal fluid (CSF) culture yield will not be affected by previous antibiotic therapy, recent publications cite a "minimum window" of 2 to 3 hours for recovery of bacterial pathogens after parenteral antibiotic administration. We conducted a retrospective review of children with bacterial meningitis to describe the rate at which parenteral antibiotic pretreatment sterilizes CSF cultures.. The medical records of pediatric patients who were discharged from a tertiary children's hospital during a 5-year period with the final diagnosis of bacterial meningitis or suspected bacterial meningitis were reviewed. The decay in yield of CSF cultures over time was evaluated in patients with lumbar punctures (LP) delayed until after initiation of parenteral antibiotics and in patients with serial LPs before and after initiation of parenteral antibiotics.. The pathogens that infected the 128 study patients were Streptococcus pneumoniae (49), Neisseria meningitidis (37), group B Streptococcus (21), Haemophilus influenzae (8), other organisms (11), and undetermined (3). Thirty-nine patients (30%) had first LPs after initiation of parenteral antibiotics, and 55 (43%) had serial LPs before and after initiation of parenteral antibiotics. After >/=50 mg/kg of a third-generation cephalosporin, 3 of 9 LPs in meningococcal meningitis were sterile within 1 hour, occurring as early as 15 minutes, and all were sterile by 2 hours. With pneumococcal disease, the first negative CSF culture occurred at 4.3 hours, with 5 of 7 cultures negative from 4 to 10 hours after initiation of parenteral antibiotics. Reduced susceptibility to beta-lactam antibiotics occurred in 11 of 46 pneumococcal isolates. Group B streptococcal cultures were positive through the first 8 hours after parenteral antibiotics. Blood cultures were positive in 74% of cases without pretreatment and in 57% to 68% of cases with negative CSF cultures.. The temptation to initiate antimicrobial therapy may override the principle of obtaining adequate pretreatment culture material. The present study demonstrates that CSF sterilization may occur more rapidly after initiation of parenteral antibiotics than previously suggested, with complete sterilization of meningococcus within 2 hours and the beginning of sterilization of pneumococcus by 4 hours into therapy. Lack of adequate culture material may result in inability to tailor therapy to antimicrobial susceptibility or in unnecessarily prolonged treatment if the clinical presentation and laboratory data cannot exclude the possibility of bacterial meningitis.

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Confidence Intervals; Female; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Patient Selection; Spinal Puncture; Time Factors

Increased total CSF lactate is an important indicator differentiating bacterial from aseptic meningitis. Bacteria can produce D- and L-lactate; mammalian cells produce only L-lactate. We measured D- and L-lactate production of Streptococcus pneumoniae, Staphylococcus aureus, Neisseria meningitidis and Escherichia coli in vitro, of S. pneumoniae and E. coli in rabbit experimental meningitis and of various common pathogens in CSF from patients with bacterial meningitis. Despite marked in vitro production of D-lactate by S. aureus (maximum: 4.59 mmol/l; i.e. 34.9% of total lactate), N. meningitidis (4.62 mmol/l; i.e. 98.1%) and E. coli (3.14 mmol/l; i.e. 97.2%), minimal amounts were measured in human S. aureus (0.38 mmol/l; i.e. 1.3% of total lactate) or N. meningitidis (0.28 mmol/l; i.e. 3.9%) and experimental E. coli meningitis (0.75 mmol/l; i.e. 4.4%). In only 9 of 54 human CSF samples did D-lactate exceed 0.15 mmol/l. S. pneumoniae did not produce significant amounts of D-lactate in vitro (maximum: 0.55 mmol/l; i.e. 2.7% of total lactate), in experimental meningitis (0.18 mmol/l; i.e. 3%) or in human cases of meningitis (0.28 mmol/l; i.e. 1.9%). In conclusion, increased total CSF lactate in meningitis consists mainly of L-lactate and originates predominantly from host cells. CSF D-lactate is of limited diagnostic value.

Topics: Animals; Bacteria; Ceftriaxone; Humans; Lactic Acid; Meningitis, Bacterial; Meningitis, Pneumococcal; Rabbits; Species Specificity; Streptococcus pneumoniae

Topics: Adolescent; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Child; Ciprofloxacin; Drug Therapy, Combination; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Salmonella Infections

A simple LC method was developed and validated for the analysis of ceftriaxone in aqueous and biological samples. Chromatographic separation was achieved on a reversed-phase C18 microbore column (Hypersil 5 microm, 200x2.1 mm) with UV detection at 270 nm. This isocratic system was operated at ambient temperature and required less than 10 min of chromatographic time. The flow-rate was maintained at 0.5 ml min(-1). Cetyltrimethylammonium bromide (0.01 M) was utilized as the ion-pairing agent. For the analysis of the drug in the aqueous system, the mobile phase consisted of methanol-acetonitrile-phosphate buffer, pH 7.4 (20:20:60, v/v/v). The plasma and CSF systems used the same mobile phase constituents in a slightly different ratio (30:40:30, v/v/v). Lidocaine was used as an internal standard and the peak height ratios of the drug to that of the internal standard were linear over the concentration range of 0.0 to 16 microg ml(-1) only in the case of aqueous systems. Within-day and day-to-day relative standard deviations ranged from 0.3 to 2.2% and 1.1 to 5.9%, respectively. This method was used to: (1) quantify ceftriaxone in an aqueous system, in rabbit plasma using a simple protein precipitation procedure, and in the CSF; (2) evaluate the permeability characteristics of ceftriaxone across the blood-brain barrier through quantification of ceftriaxone in the CSF using a microdialysis sampling technique; and (3) analyze the effects of dexamethasone (a synthetic fluorinated corticosteroid used for the relief of cerebral edema) on the permeability of ceftriaxone across the blood brain barrier through quantification of ceftriaxone in the dexamethasone-treated animals with meningitis.

Topics: Animals; Blood-Brain Barrier; Ceftriaxone; Chromatography, High Pressure Liquid; Dexamethasone; Disease Models, Animal; Meningitis, Bacterial; Microdialysis; Rabbits; Reference Standards; Reproducibility of Results; Sensitivity and Specificity; Spectrophotometry, Ultraviolet

Topics: Ceftriaxone; Cephalosporins; Cerebrospinal Fluid; Empyema, Subdural; Humans; Infant; Meningitis, Bacterial; Salmonella Infections; Salmonella typhimurium

Topics: Adult; Aminoglycosides; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Community-Acquired Infections; Cross Infection; Drug Hypersensitivity; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterococcus; Gram-Negative Bacteria; Humans; Infant, Newborn; Macrolides; Meningitis, Bacterial; Neutropenia; Penicillin Resistance; Penicillins; Pneumonia, Bacterial; Sepsis; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

The effect of CSF filtration on inflammation and neuronal damage was studied in experimental Streptococcus pneumoniae meningitis. New Zealand white rabbits received either antibiotic therapy alone (ceftriaxone i.v., 20 mg/kg bolus, 10 mg/kg maintenance dose; n = 10) or ceftriaxone plus CSF filtration (n = 11) 12 h after intracisternal infection. Immediately after the onset of antibiotic therapy 300 microliters cisternal CSF was removed, passed through a miniaturized CSF-1 filter at a constant flow of 20 microliters/min, and then reinjected. This procedure was repeated six times at intervals of 20 min. Antibiosis plus CSF filtration caused a transient reduction in CSF bacterial titers and leukocyte counts compared with antibiosis alone (P = 0.04 and 0.02 5 h after initiation of therapy). CSF lipoteichoic acid concentrations were not reduced. The concentration of neuron-specific enolase in CSF and the density of apoptotic neurons in the dentate gyrus were almost equal 12 h after the onset of treatment. Adjuvant CSF filtration accelerated the elimination of viable bacteria from CSF in comparison to antibiotic treatment alone. Parameters of neuronal destruction, however, were not reduced.

Topics: Animals; Ceftriaxone; Cephalosporins; Cerebrospinal Fluid; Filtration; Leukocyte Count; Meningitis, Bacterial; Neurons; Phosphopyruvate Hydratase; Rabbits; Streptococcal Infections

Topics: Adult; Ceftriaxone; Cephalosporins; Female; Humans; Injections, Intravenous; Meningitis, Bacterial; Streptococcal Infections; Streptococcus bovis

Haemophilus influenzae type b (Hib) still causes a large portion of meningitis in children less than 5 year old in Italy because vaccination against this agent has not been fully implemented in the country. We have studied 78 Hib strains and 4 nontypable H. influenzae (NTHi) isolated from the cerebrospinal fluid of subjects with meningitis for susceptibility to ampicillin, chloramphenicol, and ceftriaxone. The macrorestriction profiles of chromosomal DNA obtained by pulsed-field gel electrophoresis (PFGE) following digestion with SmaI and ApaI were also determined. All strains except one were equally susceptible to the antibiotics tested. One Hib strain, the only beta-lactamase producer, showed an intermediate susceptibility to ampicillin (MIC = 2 microg/ml), while maintaining full susceptibility to chloramphenicol and ceftriaxone. The analysis of the PFGE patterns showed that most of the Hib isolates, including the beta-lactamase-positive Hib strain, belonged to the same clone or to closely related subclones. For three PCR-confirmed NTHi isolates, we obtained completely different PFGE profiles. In conclusion, resistance to ampicillin still appears to be a rare finding in Hib strains causing meningitis in Italy; moreover, PFGE showed that the population structure of invasive Hib is essentially clonal.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; beta-Lactamases; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; DNA, Bacterial; Drug Resistance, Microbial; Electrophoresis, Agar Gel; Haemophilus influenzae type b; Humans; Infant; Italy; Meningitis, Bacterial; Microbial Sensitivity Tests; Middle Aged

A 2-year-old child, non immunodeficient, presented with septicemia due to Kingella kingae successively complicated by meningitis, arthritis of one knee and endocarditis. Outcome was favourable after a long and adjusted antibiotherapy, involving in particular for the endocarditis ceftriaxone (100 mg/kg/d) and amikacin (20 mg/kg/d) during 3 weeks, then amoxicillin per os (200 mg/kg/d) during 3 weeks.. Bacteriologic characteristics of the bacteria, the culture of which requires medium base with additional nutrient are reviewed. The tropism of Kingella kingae is essentially osteoarticular and cardiac as shown by the cases reported in the literature. Its susceptibility to antibiotics explains the frequent favourable outcome.

Topics: Amikacin; Amoxicillin; Arthritis, Infectious; Bacteremia; Ceftriaxone; Child, Preschool; Drug Therapy, Combination; Echocardiography; Endocarditis, Bacterial; Female; Humans; Infant; Kingella kingae; Meningitis, Bacterial; Neisseriaceae Infections

E. coli meningitis is a disease that occurs in predisposed patients, either as a result of trauma or in neonates after neurosurgery. Recurrent E. coli meningitis in an adult without any apparent predisposition is uncommon, and hydrocephalus complicating bacterial meningitis is even more rare. We report a unique case of a 67-year-old alcoholic man who had had 2 consecutive episodes of E. coli meningitis within 2 months. In both episodes there was a favorable response to ceftriaxone. However, normotensive hydrocephalus appeared a few weeks later, with mental and physical deterioration.

Topics: Aged; Alcoholism; Ceftriaxone; Cephalosporins; Escherichia coli Infections; Humans; Hydrocephalus, Normal Pressure; Male; Meningitis, Bacterial; Recurrence; Tomography, X-Ray Computed

Topics: Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Child, Preschool; Gram-Negative Bacterial Infections; Humans; Infusions, Intravenous; Meningitis, Bacterial; Vancomycin

Topics: Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Female; Humans; Infant; Magnetic Resonance Imaging; Meningitis, Bacterial; Osteomyelitis; Sacrum; Staphylococcal Infections; Staphylococcus aureus; Tomography, X-Ray Computed; Vancomycin

The clinical course for a patient hospitalized with pneumonia and meningitis due to penicillin-, ceftriaxone-, and cefotaxime-resistant Streptococcus pneumoniae is described. The pneumonia and meningitis responded to antimicrobial therapy, but the patient died following rupture of an infected abdominal aortic aneurysm; gram-positive cocci resembling S. pneumoniae were detected within the aneurysm.

Topics: Aortic Aneurysm, Abdominal; Cefotaxime; Ceftriaxone; Cephalosporins; Drug Resistance, Microbial; Humans; Male; Meningitis, Bacterial; Middle Aged; Penicillins; Pneumonia, Pneumococcal; Streptococcus pneumoniae

A 39-year-old HIV positive patient developed myalgia, headache and cough 4 weeks after a tick bite. His temperature was 37.4 degrees C and a circular pale erythema was noted over the left lower leg.. C-reactive protein was raised to 120 mg/l, white blood cell count was 5860/microliter, CD4-lymphocyte count 250/microliter. The chest radiogram showed pneumonitic infiltration in the left lower lobe. There were IgM antibodies against Borrelia burgdorferi.. Left lower lobe pneumonia and chronic erythema migrans were diagnosed and he was given oral azithromycin (500 mg on the first day and 250 mg for 4 days). The pneumonia cleared up, but 2 weeks later he developed symptoms of meningitis (496 cells per microliter, 87% lymphocytes, positive Borrelia burgdorferi antibody titer), which quickly and lastingly responded to ceftriaxon (2 g daily by brief infusion for 14 days).. This immune-compromised HIV-infected patient developed disseminated borreliosis with CNS involvement 2 weeks after the occurrence of chronic erythema migrans. The initial treatment of the latter with azithromycin was unable to prevent the meningitis. It is unlikely that there was a causal connection between the borreliosis and the pneumonia.

Topics: Adult; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Azithromycin; Borrelia burgdorferi Group; Ceftriaxone; Cephalosporins; HIV Seropositivity; Humans; Immunocompromised Host; Immunoglobulin M; Insect Bites and Stings; Lyme Disease; Male; Meningitis, Bacterial; Pneumonia; Ticks

Nontypeable Haemophilus influenzae strain INT1 was isolated from the blood of a young child with clinical signs of meningitis following acute otitis media. No immunologic or anatomic predisposition of this child for invasive bacterial infection with an unusual organism was documented. Sensitive ELISA proved the absence of intra- or extracellular capsular polysaccharide production by INT1 and Southern blot analysis confirmed the lack of an intact capsulation (cap) gene locus within the chromosome. Nevertheless, INT1 established bacteremia and meningitis in infant and weanling rat models of invasive H. influenzae infection. High-molecular-weight DNA isolated from INT1 was shown to confer an invasive phenotype on transformation of a nonencapsulated, avirulent laboratory strain of H. influenzae. Together these findings imply the presence of one or more as-yet-undiscovered, noncapsular virulence factors of H. influenzae that are capable of mediating invasive disease and resistance to immunologic clearance.

Topics: Amoxicillin; Animals; Bacteremia; Bacterial Capsules; Blotting, Southern; Ceftriaxone; Cephalosporins; Child, Preschool; DNA, Bacterial; Enzyme-Linked Immunosorbent Assay; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Meningitis, Bacterial; Otitis Media; Penicillins; Phenotype; Polysaccharides, Bacterial; Rats; Rats, Sprague-Dawley; Virulence

We report on a case of concurrent Lyme meningitis and ehrlichiosis in a patient with occupational exposure to ticks as a logger. The patient had a febrile Illness with a reticulate erythematous rash on his upper torso, meningoencephalitis, thrombocytopenia, and hepatitis. Acute and convalescent serologies were consistent with a dual infection with Lyme disease and ehrlichiosis. Ixodes scapularis is the tick that is associated with Lyme disease in our area and this tick has also been reported to harbor the species of Ehrlichia that causes human granulocytic ehrlichiosis. Empiric therapy for both Lyme disease and ehrlichiosis should be considered in any patient suspected of having a tick-borne illness and presenting with signs and symptoms compatible with both infections.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Borrelia burgdorferi Group; Ceftriaxone; Cephalosporins; Doxycycline; Drug Therapy, Combination; Ehrlichiosis; Humans; Immunoglobulin G; Immunoglobulin M; Infusions, Intravenous; Lyme Disease; Male; Meningitis, Bacterial; Occupational Diseases; Occupational Exposure

Topics: Ceftriaxone; Cephalosporins; Drug Hypersensitivity; Humans; Meningitis, Bacterial; Penicillins; Treatment Outcome

A case of group A streptococcal meningitis in a normally healthy pregnant woman is described, with a review of the literature. Streptococcus pyogenes is a very rare cause of bacterial meningitis and especially affects immunocompetent subjects. The evolution is often associated with severe neurologic deficits, but the prognosis is favourable under treatment with penicillin. In the light of the recrudescence of invasive infections, this germ could assume a more important role in bacterial meningitis comparable to that in the pre-antibiotic era.

Topics: Adult; Anti-Inflammatory Agents; Ceftriaxone; Cephalosporins; Dexamethasone; Female; Humans; Infant, Newborn; Male; Meningitis, Bacterial; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Streptococcal Infections; Streptococcus pyogenes

This paper on bacterial meningitis looks at aspects inherent in the aetiology and mechanisms underlying neurological damage and pharmacological treatment. Streptococcus pneumoniae, Haemophilus influenzae type b and Neisseria meningitidis are the pathogens most commonly responsible and are able to colonise the host's respiratory mucosae, invade the vascular space, cross the haematoliquoral barrier and survive in the cerebrospinal fluid. The presence of germs in the subarachnoid spaces leads to the onset of inflammation and neurological damage. The most often used pharmacological treatments include, apart from antibiotics, anti-inflammatory drugs (although we have clinical data for corticosteroids only), pentoxyphillin and monoclonal antibodies. Initially empiric, antibiotic therapy is based on the use of drugs that act against the probable pathogenic agents, are capable of surmounting the haematoliquoral barrier and are well tolerated. Prior to the Eighties, the antibiotic of choice was ampicillin associated or otherwise with aminoglycosides. Subsequently, the availability of new drugs (cefotaxime and ceftriaxone) and the appearance of resistance led to changes in therapeutic protocols. Of the carbapenemics, wide spectrum antibiotics with high resistance to beta lactamase, imipenem /cilastatin proved effective although there was a high risk of inducing convulsions in patients with previous neurological damage or kidney failure. Meropenem was able to surmount the haematoliquoral barrier in sufficient concentrations and was well tolerated in patients with prior neurological changes. It has proved effective in clinical studies carried out up to the present.

Topics: Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Escherichia coli; Haemophilus influenzae; Humans; Imipenem; Meningitis, Bacterial; Meropenem; Neisseria meningitidis; Streptococcus pneumoniae; Thienamycins

Whereas the diagnosis of acute neuroborreliosis by considering clinical and cerebrospinal fluid parameters is very reliable chronic neuroborreliosis is an excluding diagnosis. The clinical symptoms are uncharacteristic, and there is no reliable laboratory test permitting a safe diagnosis. Serological evidence of antibodies is no sign of activity of disease. Development of chronic infection after adequate treatment of acute neuroborreliosis seems to be very rare. We reinvestigated 15 patients half a year after antibiotic therapy of acute neuroborreliosis with regard to clinical and laboratory parameters. Most patients had a continuous intrathecal IgG antibody production against Borrelia burgdorferi, whereas no clinical signs of chronic neuroborreliosis existed. The antibody production against Borrelia burgdorferi must not be regarded as a sign of chronic infection.

Topics: Adult; Aged; Antibodies, Bacterial; Borrelia burgdorferi Group; Ceftriaxone; Chronic Disease; Female; Follow-Up Studies; Humans; Immunoglobulin G; Lyme Disease; Male; Meningitis, Bacterial; Middle Aged; Neurologic Examination; Penicillin G; Radiculopathy

We have characterized the pattern of brain injury in a rat model of meningitis caused by group B streptococci (GBS). Infant rats (12-14 days old; n = 69) were infected intracisternally with 10 microliters of GBS (log10(2.3) to 4.5 colony-forming units). Twenty hours later, illness was assessed clinically and cerebrospinal fluid was cultured. Animals were either immediately euthanized for brain histopathology or treated with antibiotics and examined later. Early GBS meningitis was characterized clinically by severe obtundation and seizures, and histopathologically by acute inflammation in the subarachnoid space and ventricles, a vasculopathy characterized by vascular engorgement, and neuronal injury that was most prominent in the cortex and often followed a vascular pattern. Incidence of seizures, vasculopathy and neuronal injury correlated with the inoculum size (p < 0.01). Early injury was almost completely prevented by treatment with dexamethasone. Within days after meningitis, injured areas became well demarcated and showed new cellular infiltrates. Thirty days post-infection, brain weights of infected animals treated with antibiotics were decreased compared to uninfected controls (1.39 +/- 0.18 vs 1.64 +/- 0.1 g; p < 0.05). Thus, GBS meningitis in this model caused extensive cortical neuronal injury resembling severe neonatal meningitis in humans.

Topics: Animals; Animals, Newborn; Brain Damage, Chronic; Ceftriaxone; Cerebral Cortex; Cerebral Ventricles; Consciousness Disorders; Dexamethasone; Granulocytes; Meningitis, Bacterial; Neurons; Organ Size; Rats; Rats, Sprague-Dawley; Seizures; Severity of Illness Index; Streptococcal Infections; Streptococcus agalactiae; Subarachnoid Space; Vasculitis

Although the pharmacokinetics of ceftriaxone allows its administration in a single daily dose, this practice is not standard in the treatment of bacterial meningitis. Herein, we review our experience and that of other investigators with this mode of therapy. We used a single daily dose of ceftriaxone (50 mg/[kg.d]; maximum, 4 g/d) for the treatment of bacterial meningitis in 84 adult patients. Meningitis was due to Neisseria meningitidis in 34 cases, to Streptococcus pneumoniae in 25, to Escherichia coli in three, to Klebsiella pneumoniae in two, to Haemophilus influenzae in two, to viridans streptococci in two, and to an unknown agent in 16. Eleven patients died, for an overall mortality of 13%; therapy failed in three additional cases. The mean trough levels of ceftriaxone in cerebrospinal fluid was 3.5 micrograms/mL; the median trough bactericidal titer at this site was 1:128. Both our experience and that in the literature suggest that a single daily dose is optimal when ceftriaxone is used for the treatment of bacterial meningitis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ceftriaxone; Female; Humans; Male; Meningitis, Bacterial; Middle Aged

Topics: Adolescent; Adult; Bangladesh; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Hospitals, Special; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Microbial Sensitivity Tests; Retrospective Studies

Topics: Anti-Infective Agents; Ceftriaxone; Cephalosporins; Ciprofloxacin; Female; Humans; Immunocompromised Host; Lupus Erythematosus, Systemic; Meningitis, Bacterial; Middle Aged; Salmonella Infections

Meropenem and comparator antibiotics, including ceftriaxone, ceftazidime, benzyl penicillin and a combination of ampicillin plus gentamicin, were evaluated in a model of bacterial meningitis in the guinea-pig. The model is an acute infection in which challenge with each organism, if untreated, causes an increase in numbers of white blood cells, elevation of protein concentrations and 6-8 log10 cfu/mL of bacteria in the CSF. Infections caused by Haemophilus influenzae, Neisseria meningitidis, three strains of Streptococcus pneumoniae (two penicillin-resistant), Escherichia coli, Pseudomonas aeruginosa and Listeria monocytogenes all responded to meropenem, which was as active as the comparator agents in all studies, and was more active in most. Of particular note were the results seen against S. pneumoniae (penicillin-resistant) infections, in which meropenem was significantly more effective than ceftriaxone. Also notable were results from the P. aeruginosa infection where meropenem, at low doses, was more effective than ceftazidime. Activity against L. monocytogenes was equivalent to that produced by treatment with the combination of ampicillin plus gentamicin, even when treatment was delayed. These results show that, in an animal model, meropenem penetrates into CSF in concentrations sufficient to produce significant reductions in the numbers of common and less common pathogens.

Topics: Ampicillin; Animals; Carbapenems; Ceftazidime; Ceftriaxone; Cephalosporins; Cerebrospinal Fluid; Cerebrospinal Fluid Proteins; Drug Evaluation; Drug Resistance, Microbial; Escherichia coli Infections; Gentamicins; Guinea Pigs; Haemophilus Infections; Haemophilus influenzae; Listeriosis; Meningitis, Bacterial; Meropenem; Neisseria meningitidis; Penicillin G; Pneumococcal Infections; Thienamycins

Between 1986 and 1992, 60 children with facial nerve palsy (FNP) were examined at the ORL hospital at Erlangen-Nuremberg University. By using blood and cerebrospinal fluid (CSF)-serological tests acute infection with Borrelia burgdorferi (B.b.) could be proved in 16 of 40 children (40%) whose pareses could not be clarified etiologically at first examination. Whereas all idiopathic FNP patients (22) had normal CSF-results, more than half of the B.b.-infected children showed pathological findings, with pleocytosis indicating meningitis. These findings demonstrated that lumbar puncture should be performed in children with FNP of unclear etiology, particularly in cases with positive borreliosis blood serology. The children with borreliosis received penicillin G or ceftriaxone intravenously for at least 14 days and patients with idiopathic FNP were treated with cortisone either orally alone or intravenously in combination with pentoxifylline and hydroxyethylstarch. The outcome in 95% of the patients showed that complete recovery was similar in borreliosis and idiopathic FNP irrespective of treatment with cortisone. Overall, 88% of the FNP recovered completely, indicating a favorable prognosis of FNP in children.

Topics: Adolescent; Antibodies, Bacterial; Borrelia burgdorferi Group; Ceftriaxone; Child; Child, Preschool; Cortisone; Diagnosis, Differential; Facial Paralysis; Female; Humans; Lyme Disease; Male; Meningitis, Bacterial; Penicillin G; Pentoxifylline

Two leading causes of hearing loss in infants and young children have been bacterial meningitis due to Haemophilus influenzae Type b (Hib) and congenital toxoplasmosis. In this two-part review, we describe the essential nature and incidence of these two diseases and how the availability of a Hib vaccine effective and safe with infants as young as 2 mo of age; the prospect of universal immunization against Hib disease; the introduction of cephalosporin antibiotic and corticosteroid treatment; and the use of early and prolonged antimicrobial therapy with children with congenital toxoplasmosis promises significant reduction, if not complete eradication, of hearing loss in infants and toddlers attributable to Hib bacterial meningitis and congenital toxoplasmosis. As a result, there may be up to a third fewer children under the age of five with severe hearing impairment annually in the United States.

Topics: Ceftriaxone; Cefuroxime; Child, Preschool; Dexamethasone; Haemophilus influenzae; Hearing Disorders; Hearing Loss, Sensorineural; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Streptococcus; Toxoplasmosis, Congenital; United States

Topics: Ceftriaxone; Child; Dacryocystorhinostomy; Dexamethasone; Female; Humans; Meningitis, Bacterial; Pneumococcal Infections

The penetration of ceftriaxone into cerebrospinal fluid (CSF) was studied with 11 children (mean age: 2 years, 4 months; range: 4 months to 8 years) with meningitis, receiving dexamethasone (0.15 mg/kg of body weight intravenously four times daily) as adjunctive therapy. Ceftriaxone was given intravenously at doses of 50 mg/kg twice daily to patients < 18 months old and 100 mg/kg once daily to patients > or = 18 months old. CSF was collected after 1 day of treatment at the expected peak concentration of ceftriaxone in CSF. Concentrations of ceftriaxone in CSF ranged from 0.7 to 9.2 mg/liter, with a mean value of 4.0 (standard deviation [SD], 2.9) mg/liter. Values were significantly higher for patients with CSF glucose levels of < 1 mmol/liter on admission to the hospital than for patients with CSF glucose levels of > or = 1 mmol/liter (mean values of 7.1 [SD, 2.2] mg/liter versus 2.2 [SD, 1.1] mg/liter; P < 0.001). After 1 day of treatment, ceftriaxone concentrations in the CSF of children receiving dexamethasone are similar to the mean values reported for children not treated with dexamethasone.

Topics: Ceftriaxone; Child; Child, Preschool; Dexamethasone; Glucose; Humans; Infant; Injections, Intravenous; Meningitis, Bacterial

Topics: Amoxicillin; Bacteremia; Ceftriaxone; Child, Preschool; Fever; Humans; Meningitis, Bacterial

Topics: Aged; Ampicillin; Ceftriaxone; Drug Therapy, Combination; Female; Humans; Meningitis, Bacterial

Topics: Anti-Bacterial Agents; Ceftriaxone; Fever of Unknown Origin; Humans; Infant; Infusions, Intravenous; Injections, Intramuscular; Meningitis, Bacterial

We evaluated the pharmacokinetics and therapeutic efficacy of ampicillin combined with sulbactam in a rabbit model of meningitis due to a beta-lactamase-producing strain of Escherichia coli K-1. Ceftriaxone was used as a comparison drug. The MIC and MBC were 32 and greater than 64 micrograms/ml (ampicillin), greater than 256 and greater than 256 micrograms/ml (sulbactam), 2.0 and 4.0 micrograms/ml (ampicillin-sulbactam [2:1 ratio, ampicillin concentration]) and 0.125 and 0.25 micrograms/ml (ceftriaxone). All antibiotics were given by intravenous bolus injection in a number of dosing regimens. Ampicillin and sulbactam achieved high concentrations in cerebrospinal fluid (CSF) with higher dose regimens, but only moderate bactericidal activity compared with that of ceftriaxone was obtained. CSF bacterial titers were reduced by 0.6 +/- 0.3 log10 CFU/ml/h with the highest ampicillin-sulbactam dose used (500 and 500 mg/kg of body weight, two doses). This was similar to the bactericidal activity achieved by low-dose ceftriaxone (10 mg/kg), while a higher ceftriaxone dose (100 mg/kg) produced a significant increase in bactericidal activity (1.1 +/- 0.4 log10 CFU/ml/h). It appears that ampicillin-sulbactam, despite favorable CSF pharmacokinetics in animals with meningitis, may be of limited value in the treatment of difficult-to-treat beta-lactamase-producing bacteria, against which the combination shows only moderate in vitro activity.

Topics: Ampicillin; Animals; beta-Lactamases; Ceftriaxone; Drug Therapy, Combination; Escherichia coli Infections; Injections, Intravenous; Meningitis, Bacterial; Microbial Sensitivity Tests; Rabbits; Sulbactam

This is review of our experience in the treatment of meningitis carried out at the Naval Medical Research Unit No. 3 (NAMRU-3), Cairo, Egypt since 1967. We have demonstrated that the serum and cerebrospinal fluid concentrations of ampicillin and its efficacy when used in the treatment of meningitis are comparable whether they are administered intravenously or intramuscularly. The third generation cephalosporin ceftriaxone was found to be very safe and effective when administered intramuscularly once a day in the treatment of the different types of acute bacterial meningitis. Aztreonam given intramuscularly was successful in the treatment of Gram-negative meningitis caused by multi-resistant organisms. The fatality rates and morbidity were significantly reduced in patients with meningitis when dexamethasone was given in conjunction with antibacterial chemotherapy.

Topics: Adult; Ampicillin; Ceftriaxone; Child; Chloramphenicol; Dexamethasone; Drug Therapy, Combination; Egypt; Humans; Injections, Intramuscular; Injections, Intravenous; Meningitis, Bacterial; Penicillins; Sulfadiazine

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Multicenter Studies as Topic; Survival Analysis; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Controlled Clinical Trials as Topic; Humans; Meningitis, Bacterial; Piperacillin; Treatment Outcome