The Treatment of Pseudomonas aeruginosa Meningitis Old Regime or Newer Drugs?

Abstract

Currently intravenous ceftazidime with or without an aminoglycoside or alternatively ciprofloxacin are the recommended antibiotics of choice in Pseudomonas aeruginosa meningitis. A case of atraumatic, spontaneous Ps. aeruginosa meningitis in a child with acute lymphoblastic leukaemia is described. Despite the organism demonstrating in vitro sensitivity to ceftazidime, netilmicin and ciprofloxacin, intravenous therapy with these drugs failed to sterilise the cerebrospinal fluid (CSF). Both netilmicin and ciprofloxacin failed to attain therapeutic levels in the CSF. Intrathecal aminoglycoside therapy via an intraventricular reservoir was successful in eradicating the infection. In children with meningitis due to Ps. aeruginosa where intravenous therapy is unsuccessful despite in vitro sensitivity to recommended antibiotics; intraventricular medications should be commenced as soon as possible.

Evaluation of antimicrobial regimens in a guinea-pig model of meningitis caused by Pseudomonas aeruginosa

“…If tobramycin was associated with ceftazidime when CSF WBC was already low, the percentage of animals with a positive meningeal swab fell to 11%. The frequent recurrences with the current recommended therapy may be due to hidden bacterial populations in the meninge though CSF is broadly normal and suggest the need for extended treatments [2,6,7,10,11].…”

“…Clinical success with meropenem or intratecal aminoglycosides has been reported in individuals who failed to conventional therapy [10e13]. Meropenem shows good activity, has a significant post-antibiotic effect against P. aeruginosa [14], is well tolerated in high doses [15,16] and has been successfully used to treat multiresistant P. aeruginosa meningitis [10,11,17]. Because this diagnosis is rare, controlled trials of antimicrobial agents are not possible.…”

“…The current therapy with ceftazidime, as monotherapy or with a systemic aminoglycoside [7e9] is not always effective [10] and the frequent resistance of P. aeruginosa gives rise to therapeutic failures and relapses that prompt the search for alternatives such as ciprofloxacin, meropenem or intratecal aminoglycosides. Clinical success with meropenem or intratecal aminoglycosides has been reported in individuals who failed to conventional therapy [10e13].…”