COMPARATIVE TRIAL OF CEFTRIAXONE (CTX) VS. AMPICILLIN/CHLORAMPHENICOL (A/C) THERAPY (Rx) FOR BACTERIAL MENINGITIS IN CHILDREN

Abstract

Forty-five patients, 3 mo-5 yr in age, were randomly assigned Rx with CTX (23 pts) - loading dose of 75 mg/kg followed by 50 mg/kg q 12 hr or A/C (22 pts) - 50/25 mg/kg q 6 hr. The groups were comparable in age, sex, race, days and severity of illness before admission, etiology and admission CSF bacterial colony counts. The pathogens were H. flu type b (31 β-lactamase neg, 7 β-lactamase pos), S. pneumoniae (4), and N. meningitidis (3). Initial CSF colony counts ranged from 2.5×10² - 1×10¹⁰ CFU/ml. In 39 pts, an LP was repeated 10.5-18 hrs after starting Rx: 13/20 CTX and 11/19 A/C pts had sterile cultures. Mean falls in the CSF bacterial colony counts were 6.4 and 6.2 log₁₀ CFU/ml, respectively. CTX MICs for the H. flu isolates ranged from 0.0004-0.006 μg/ml. CTX CSF levels ranged from 1.0-8.0 μg/ml, representing a mean CSF penetration of 9.4% (range 1.2-24.5%) of the simultaneous serum concentration. Median CSF bactericidal titers were ≥1:1024 for CTX and 1:8 for A/C. There was no difference in the clinical course as to the time of defervescence, seizures or hearing loss. However, one relapse occurred in the CTX group. Adverse reactions in the CTX/A/C groups included neutropenia-2/5, eosinophilia-6/8, thrombocytosis-15/17, elevated SGOT/SGPT-2/2, hyperbilirubinemia-3/0, prolonged prothrombin time-1/1, rash-0/1 and diarrhea-11/4. CXT appears to be safe and as effective as A/C therapy for bacterial meningitis in children.

Log in or create a free account to read this content

Gain free access to this article, as well as selected content from this journal and more on nature.com

Access through your institution

or

Sign in or create an account

Continue with Google

Continue with ORCiD