Adjuvant glycerol is not beneficial in experimental pneumococcal meningitis

Blaser, Cornelia; Klein, Matthias; Grandgirard, Denis; Wittwer, Matthias; Peltola, Heikki; Weigand, Michael; Koedel, Uwe; Leib, Stephen L.

doi:10.1186/1471-2334-10-84

Cited by 21 publications

(8 citation statements)

References 13 publications

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“…Matrix metalloproteinase-9 (MMP-9) concentrations in CSF were significantly lower in glycerol-treated rats at 40 h after infection. This difference in MMP-9 in late disease did not result in an improvement of histopathologic parameters [133], that is, no clear beneficial effect of glycerol could be demonstrated in animal models of bacterial meningitis.…”

Section: Glycerol and Other Intracranial Pressure-lowering Agentsmentioning

confidence: 97%

Bacterial meningitis: an update of new treatment options

Nau

Djukic

Spreer

et al. 2015

Expert Review of Anti-infective Therapy

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The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case-control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.

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Section: Glycerol and Other Intracranial Pressure-lowering Agentsmentioning

confidence: 97%

Bacterial meningitis: an update of new treatment options

Nau

Djukic

Spreer

et al. 2015

Expert Review of Anti-infective Therapy

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“…128 However, to date, there is insufficient clinical or experimental evidence to support glycerol therapy for BM. 141,142 …”

Section: Glycerol Therapymentioning

confidence: 98%

Meningitis in Neonates: Bench to Bedside

Grandgirard

Leib

2010

Clinics in Perinatology

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“…To date, however, little is known about possible interactions between ceftriaxone and MMPs since current experiments are mainly on rodent models of meningitis experimenting the effect of other MMP inhibitors (e.g. Ro 32-3555 or GM6001) on neuronal loss or learning abilities with ceftriaxone only as a comedication [31,32,33,34,35,36,37]. Since studies on minocycline show a 2-fold decrease and ceftriaxone in current analysis showed a 3-fold increase in post-IVT-sICH rate, an identical effect of ceftriaxone on MMPs seems unlikely.…”

Section: Discussionmentioning

confidence: 99%

Preventive Ceftriaxone in Patients with Stroke Treated with Intravenous Thrombolysis: Post Hoc Analysis of the Preventive Antibiotics in Stroke Study

et al. 2016

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Background: The Preventive Antibiotics in Stroke Study (PASS), a randomized open-label masked endpoint trial, showed that preventive ceftriaxone did not improve functional outcome at 3 months in patients with acute stroke (adjusted common OR 0.95; 95% CI 0.82-1.09). Post-hoc analyses showed that among patients who received intravenous thrombolysis (IVT), patients who received ceftriaxone had a significantly better outcome as compared with the control group. This study aimed to gain more insight into the characteristics of these patients. Methods: In PASS, 2,550 patients were randomly assigned to preventive antibiotic treatment with ceftriaxone or standard care. In current post-hoc analysis, 836 patients who received IVT were included. Primary outcome included functional status on the modified Rankin Scale, analyzed with adjusted ordinal regression. Secondary outcomes included infection rate and symptomatic intracerebral hemorrhage (sICH) rate. Results: For all patients in PASS, the p value for the interaction between IVT and preventive ceftriaxone regarding functional outcome was 0.03. Of the 836 IVT-treated patients, 437 were administered ceftriaxone and 399 were allocated to the control group. Baseline characteristics were similar. In the IVT subgroup, preventive ceftriaxone was associated with a significant reduction in unfavorable outcome (adjusted common OR 0.77; 95% CI 0.61-0.99; p = 0.04). Mortality at 3 months was similar (OR 0.75; 95% CI 0.48-1.18). Preventive ceftriaxone was associated with a reduction in infections (OR 0.43; 95% CI 0.28-0.66), and a trend towards an increased risk for sICH (OR 3.09; 95% CI 0.85-11.31). Timing of ceftriaxone administration did not influence the outcome (aOR 1.00; 95% CI 0.98-1.03; p = 0.85). Conclusions: According to the post-hoc analysis of PASS, preventive ceftriaxone may improve the functional outcome in IVT-treated patients with acute stroke, despite a trend towards an increased rate of post-IVT-sICH.

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Adjuvant glycerol is not beneficial in experimental pneumococcal meningitis

Cited by 21 publications

References 13 publications

Bacterial meningitis: an update of new treatment options

Bacterial meningitis: an update of new treatment options

Meningitis in Neonates: Bench to Bedside

Preventive Ceftriaxone in Patients with Stroke Treated with Intravenous Thrombolysis: Post Hoc Analysis of the Preventive Antibiotics in Stroke Study

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