Cefuroxime treatment of bacterial meningitis in infants and children

Abstract

Recently, ampicillin- and chloramphenicol-resistant strains of Haemophilus influenzae type b and multiply-resistant Salmonella strains have appeared in some areas of the world. Therefore, alternative drug therapy for infections caused by these organisms is being sought. We used cefuroxime to successfully treat five children with H. influenzae type b meningitis and two children with Salmonella meningitis. Four H. influenzae type b isolates and one Salmonella isolate were resistant to ampicillin, chloramphenicol, and cotrimoxazole. Each of the patients received 200 to 250 mg of cefuroxime per kg per day in four divided doses for 14 to 21 days. The concentrations of cefuroxime in cerebrospinal fluid at 2 h after intravenous 50-mg/kg doses were 6.4 +/- 1.7 (mean +/- standard deviation) and 3.6 +/- 2.2 micrograms/ml on days 2 and 14 of treatment, respectively. The level of drug in cerebrospinal fluid was 1.34 +/- 1.3 micrograms/ml in children without meningitis. The mean cefuroxime concentration in subdural fluid samples from each of three patients was 12.6, 15, and 25.2 micrograms/ml. Cefuroxime is recommended as an alternative drug for the treatment of H. influenzae type b meningitis, but additional information is necessary before cefuroxime can be recommended for therapy of Salmonella meningitis.

Concentrations of Cefuroxime in Brain Tissue of Neurointensive Care Patients

“…However, the CSF levels (0.35 to 1.76 mg/liter and 0.15 to 2.03 mg/liter after 1.5 and 6 h, respectively) were considerably lower than the interstitial brain tissue concentrations in our cohort (26). Other studies support that in patients without CNS infection CSF concentrations of cefuroxime are much lower than brain tissue concentrations, thereby failing to reflect cefuroxime concentrations within the cerebral interstitial space, the ultimate target site of antibiotic activity (26,27). Since CNS infections cause an increase of the permeability of the blood-CSF/blood-brain barrier, CSF levels during the acute phase of bacterial meningitis were reported as high as in our cohort (27)(28)(29)(30).…”

Effect of Severity Disease on the Pharmacokinetics of Cefuroxime in Children with Multiple Organ System Failure

“…Cefuroxime (CXM) is a second generation cephalosporin antibiotic that is active against Gram-positive and Gram-negative bacteria 1,2) and is a cephalosporin with enhanced b-lactamase resistance.…”

Salmonella Meningitis: Report of Three Cases in Adults and Literature Review

“…Therapeutic failures may be due to high minimal inhibitory concentrations (MICs) [46,47]. The MIC for ceftriaxone was < 0.25 for all our isolates, yet our patient with purulent meningitis required 24 days of parenteral therapy.…”

“…and emerging resistance to both cephalosporins and quinolones [47][48][49][50][51], antibiotic susceptibility studies for each isolate should determine the drug of choice. The quinolones demonstrate excellent activity against Salmonella and penetrate the CSF better than any other class of antibiotic [52,53].…”