Ceftriaxone versus penicillin G in the short-term treatment of meningococcal meningitis in adults

Abstract

Short-term treatment with ceftriaxone 2 g once daily for two days (group 1) was compared to treatment with a standard regimen of penicillin G (group 2) for six days in adults with meningococcal meningitis. Thirty-six patients were allocated in a randomized fashion to a treatment group: 16 to group 1 and 20 to group 2. The clinical and microbiological results were comparable in the two treatment groups. In both groups cultures of cerebrospinal fluid were sterile after 24 hours. One patient in each group died. In group 1 one case of fulminant meningococcemia and one case of brain abscess required further antibiotic treatment. It is concluded that short-term treatment with ceftriaxone is feasible but patients with severe forms of meningitis would not be eligible for treatment with this regimen, and careful follow-up of the patients receiving ceftriaxone is necessary.

Short course intravenous benzylpenicillin treatment of adults with meningococcal disease

“…As there were no relapses in this series, 3 days of treatment is sufficient. It is of interest that all three patients who received 1 or 2 days of treatment were cured, supporting previous data that even 2 days of treatment might be sufficient 13 …”

“…There are now several adult and paediatric studies, including two from our unit, of short‐course β‐lactam treatment consisting of 4−5 days duration for meningococcal meningitis 4−9 and meningococcal disease 10−12 . In a further study, the majority of patients in one arm successfully received 2 days of ceftriaxone treatment for meningococcal meningitis 13 . In the aforementioned studies, 280 patients received no more than 5 days of treatment with a β‐lactam antibiotic.…”

Short versus long duration of antibiotic therapy for bacterial meningitis: a meta-analysis of randomised controlled trials in children

“…In particular, a randomised, open label trial on epidemic meningococcal meningitis demonstrated the non-inferiority of treatment consisting of a single dose of ceftriaxone compared with standard treatment with a single dose of long-acting oily chloramphenicol 20. Moreover, a 2-day regimen of ceftriaxone was found comparable in clinical and microbiological terms to a 6-day regimen of penicillin G in a small randomised trial, although patients with severe disease in the ceftriaxone arm required further treatment 21. Small non-randomised trials have also shown favourable outcomes with a 4–5-day treatment of meningococcal meningitis using appropriate antibacterial agents 22 23.…”

“…These agents have been shown to reach CSF concentrations that are many times higher than the minimum inhibitory concentration for most causative pathogens 24 27. Accordingly, sterilisation of the CSF can be documented during the first or the second day of therapy in most cases 21 24 28. In fact, in the RCT included in our meta-analysis that provided relevant data, early repeat CSF cultures were negative 15 17.…”