Experience with sulphamethoxazole (SMZ)/trimethoprim (TMP) combination in purulent meningitis not responding to conventional microbial therapy

Sumarmo,; Mugiyo, K. U.; Mandoyono,; Lauritha, S P; Suntoro, A

doi:10.14238/pi21.1-2.1981.11-20

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“…Despite this, there are case reports of successful outcomes with the use of TMP/SMX in neonatal meningitis. 25,26 The published cases of neonatal meningitis caused by Elizabethkingia spp. provided guidance for selecting the TMP/SMX dosing regimen of 5 mg/kg/ dose (of TMP) every 12 hours.…”

Section: Discussionmentioning

confidence: 99%

Successful Eradication of a Highly Resistant Elizabethkingia anophelis Species in a Premature Neonate With Bacteremia and Meningitis

Hartley,

Morrisette,

Malloy

et al. 2023

Pediatric Infectious Disease Journal

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Elizabethkingia anophelis is a Gram-negative bacillus that can exhibit highly resistant phenotypes against most antibiotics with evidence of efficacy and safety in the neonatal population. Given the limited antimicrobial options, clinicians may be forced into challenging treatment scenarios when faced with central nervous system infections in premature neonates caused by E. anophelis. We report a case of successful treatment of hospital-acquired meningitis and bacteremia caused by E. anophelis at 11 days of life in a male infant born at 29 weeks, 1 day gestation and birth weight of 1.41 kg. Therapy consisted of vancomycin, dose adjusted to maintain goal troughs of 15–20 mg/L, and rifampin 10 mg/kg/dose every 12 hours, with ciprofloxacin 15 mg/kg/dose every 12 hours and trimethoprim/sulfamethoxazole 5 mg/kg/dose every 12 hours added due to antimicrobial susceptibilities and unsatisfactory response, for a total of 21 days. Following initiation of this multidrug regimen, repeat cultures were negative, laboratory parameters improved [with exception of elevated cerebrospinal fluid (CSF) white blood cell count], the patient remained otherwise stable, and there were no adverse effects noted from therapy. Complications after treatment included the requirement of bilateral hearing aids and the development of hydrocephalus necessitating ventriculoperitoneal shunt placement. To our knowledge, we report the first case of meningitis in a premature neonate initially identified as E. anophelis in the United States treated with this regimen which led to successful microbiologic eradication with no antimicrobial safety concerns.

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Section: Discussionmentioning

confidence: 99%

Successful Eradication of a Highly Resistant Elizabethkingia anophelis Species in a Premature Neonate With Bacteremia and Meningitis

Hartley,

Morrisette,

Malloy

et al. 2023

Pediatric Infectious Disease Journal

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Experience with sulphamethoxazole (SMZ)/trimethoprim (TMP) combination in purulent meningitis not responding to conventional microbial therapy

Abstract: 11Tell infants ranging in age frolll two days to nillc mOllths with purulent meningitis who lvere cOllsidered therapeutic failufes after cOllvelIliollal microbial therapy (i.e. ampicillin, chloramphenicol, gelllamicill, llll1ikill. cloxacillin in ally combination) Show more

Cited by 1 publication

References 2 publications

Successful Eradication of a Highly Resistant Elizabethkingia anophelis Species in a Premature Neonate With Bacteremia and Meningitis

Successful Eradication of a Highly Resistant Elizabethkingia anophelis Species in a Premature Neonate With Bacteremia and Meningitis

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