Intrathecal antibiotic therapy for neonatal meningitis.

Yeung, Chun‐Yan

doi:10.1136/adc.51.9.686

Cited by 27 publications

(24 citation statements)

References 17 publications

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“…Our initial dose of 2 mg was selected using previously published case reports [4][5][6][7][8][9] and studies. [10][11][12][13][14][15][16] Doses of IVT tobramycin ranging from 1.5-2 mg were used in our patient to achieve CSF concentrations of 20-30 µg/mL. The initial dose of 2 mg was selected using previously published case reports [4][5][6][7][8][9] and studies.…”

Section: Discussionmentioning

confidence: 99%

“…The initial dose of 2 mg was selected using previously published case reports [4][5][6][7][8][9] and studies. [10][11][12][13][14][15][16] Similar to earlier reports, 8,11,14,16 we employed a CSF goal concentration of 20-30 µg/mL in order to achieve tobramycin concentrations that were at least five times the minimal inhibitory concentration (MIC) of the organism in the CSF (<4 µg/mL). Traditionally, aminoglycosides are dosed by targeting a serum peak-to-MIC ratio of 5:10.…”

Section: Discussionmentioning

confidence: 99%

“…7 Unlike the MBC of 3.12 µg/mL reported by Pickering et al the gentamicin MIC of the or- CSF antibiotic concentrations and dosing requirements have been shown to vary based upon patient disease characteristics (e.g., hydrocephalus), type, and severity of infection. [4][5][6][7][8][9][10][11][12][13][14][15] Olsen and colleagues described a 6-month-old infant with hydrocephalus and a ventriculoperitoneal (VP) shunt who developed P aeruginosa ventriculitis. 6 Monotherapy with intramuscular (IM) and IVT gentamicin was initiated at a daily dose of 3 mg/ kg and 1 mg, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…1,8,12,13,[15][16][17][18] Yeung reported an infant who exhibited signs of deafness during the fifth week of therapy for E coli meningitis. 12 The infant was only receiving systemic gentamicin and ampicillin, but had previously received 20 days of IVT and 16 days of IT gentamicin therapy. The systemic gentamicin was discontinued when the infant failed to respond to rattles and a music box as he had earlier during therapy.…”

Section: Discussionmentioning

confidence: 99%

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Intraventricular Tobramycin in a Premature Infant with Pseudomonas Meningitis

Eiland

Luedtke

2004

The Journal of Pediatric Pharmacology and Therapeutics

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A 38-week postconceptional age (29-week gestational age) infant required the placement of an Ommaya reservoir following a grade IV intraventricular hemorrhage and progressive hydrocephalus. At 70 days of age, a cerebrospinal fluid (CSF) culture was positive for Pseudomonas aeruginosa and the infant was empirically treated with age-appropriate parenteral doses of ceftazidime and gentamicin. This antibiotic regimen was changed to meropenem and tobramycin following the results of sensitivity reports. The infection failed to respond despite aggressive systemic dosing of antibiotics and removal of the Ommaya reservoir. Intraventricular injections of tobramycin were added to the systemic antibiotic regimen at a dose of 2 mg daily with subsequent doses adjusted to maintain trough concentrations in the CSF of 20-30 µg/mL. The CSF was sterilized after three days of intraventricular injections. The infant completed seven days of intraventricular tobramycin plus a 24-day regimen of systemic antibiotics. No acute complications were noted with the addition of intraventricular injections.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intraventricular Tobramycin in a Premature Infant with Pseudomonas Meningitis

Eiland

Luedtke

2004

The Journal of Pediatric Pharmacology and Therapeutics

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“…However, for inclusion in the study group, only three days of intrathecal therapy were required. Intrathecal therapy only achieves low concentrations in the ventricular cerebrospinal fluid in adult (Kaiser and McGee, 1975) , and paediatric patients (Moellering and Fische'r, 1972;Yeung, 1976). Direct installation of gentamicin into the ventricles, or installation via a Rickham reservoir is rational therapy, but no controlled evaluation has been carried out (Bz.…”

Section: In Most Recently Reported Series Group Bmentioning

confidence: 99%

Neonatal Meningococcal Meningitis

Gillam¹

1977

J Paediatr Child Health

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Global Case Fatality of Bacterial Meningitis During an 80-Year Period

van Ettekoven,

Liechti,

Brouwer

et al. 2024

JAMA Netw Open

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ImportanceThe impact of vaccination, antibiotics, and anti-inflammatory treatment on pathogen distribution and outcome of bacterial meningitis over the past century is uncertain.ObjectiveTo describe worldwide pathogen distribution and case fatality ratios of community-acquired bacterial meningitis.Data SourcesGoogle Scholar and MEDLINE were searched in January 2022 using the search terms bacterial meningitis and mortality.Study SelectionIncluded studies reported at least 10 patients with bacterial meningitis and survival status. Studies that selected participants by a specific risk factor, had a mean observation period before 1940, or had more than 10% of patients with health care–associated meningitis, tuberculous meningitis, or missing outcome were excluded.Data Extraction and SynthesisData were extracted by 1 author and verified by a second author. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Random-effects models stratified by age (ie, neonates, children, adults), Human Development Index (ie, low-income or high-income countries), and decade and meta-regression using the study period’s year as an estimator variable were used.Main Outcome and MeasureCase fatality ratios of bacterial meningitis.ResultsThis review included 371 studies performed in 108 countries from January 1, 1935, to December 31, 2019, describing 157 656 episodes. Of the 33 295 episodes for which the patients’ sex was reported, 13 452 (40%) occurred in females. Causative pathogens were reported in 104 598 episodes with Neisseria meningitidis in 26 344 (25%) episodes, Streptococcus pneumoniae in 26 035 (25%) episodes, Haemophilus influenzae in 22 722 (22%), other bacteria in 19 161 (18%) episodes, and unidentified pathogen in 10 336 (10%) episodes. The overall case fatality ratio was 18% (95% CI, 16%-19%), decreasing from 32% (95% CI, 24%-40%) before 1961 to 15% (95% CI, 12%-19%) after 2010. It was highest in meningitis caused by Listeria monocytogenes at 27% (95% CI, 24%-31%) and pneumococci at 24% (95% CI, 22%-26%), compared with meningitis caused by meningococci at 9% (95% CI, 8%-10%) or H influenzae at 11% (95% CI, 10%-13%). Meta-regression showed decreasing case fatality ratios overall and stratified by S pneumoniae, Escherichia coli, or Streptococcus agalactiae (P &lt; .001).Conclusions and RelevanceIn this meta-analysis with meta-regression, declining case fatality ratios of community-acquired bacterial meningitis throughout the last century were observed, but a high burden of disease remained.

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Intrathecal antibiotic therapy for neonatal meningitis.

Cited by 27 publications

References 17 publications

Intraventricular Tobramycin in a Premature Infant with Pseudomonas Meningitis

Intraventricular Tobramycin in a Premature Infant with Pseudomonas Meningitis

Neonatal Meningococcal Meningitis

Global Case Fatality of Bacterial Meningitis During an 80-Year Period

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