Ventriculitis Complicating Meningitis

Salmon, James H.

doi:10.1001/archpedi.1972.02110130037005

Cited by 51 publications

(29 citation statements)

References 10 publications

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“…coli and the Klebsiella-Enterobacter group are the most common causative pathogens in neonatal meningitis and post-neurosurgical meningitis in adults (11,13,20). Many strains of these bacteria (including ampicillin-resistant strains) are susceptible to mecillinam in vitro.…”

mentioning

confidence: 99%

Mecillinam-Ampicillin Synergism in Experimental Enterobacteriaceae Meningitis

Scheld

Fink

Fletcher

et al. 1979

Antimicrob Agents Chemother

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The in vitro activities of mecillinam, a new f)-amidinopenicilhin, and ampicillin, alone and in combination, against an Escherichia coli strain and a Klebsiella pneumoniae strain were compared, and these results were correlated with their respective activities in vivo in experimental meningitis. The mecillinam-ampicillin combination was synergistic in vitro against both strains when tested by a modified checkerboard technique (bacteriostatic synergy). However when quantitative bactericidal synergy studies were made, the relative bactericidal rate of the combination was more rapid than that of either drug alone ("bactericidal synergy") against the Escherichia coli isolate only. In a rabbit model of Enterobacteriaceae meningitis, in vivo bactericidal activity correlated with results obtained in vitro. Both drugs were administered by continuous intravenous infusion for 8 h. Serum and cerebrospinal fluid antibiotic levels were similar to those achieved in humans. Cerebrospinal fluid bacterial concentrations (colonyforming units [CFU] per milliliter) were quantitatively titrated at 2-h intervals. Both drugs, alone or the combination, were ineffective against the K. pneumoniae strain in vivo (change in titer <1 log in 8 h). In contrast, the combination produced a markedly enhanced bactericidal effect against the E. coli strain (mean + standard deviation, decrease of log1o CFU per milliliter of 3.65 ± 1.02) compared with those of ampicillin alone (decrease of log1o CFU per milliter of 0.07 ± 0.8) and mecillinam alone (decrease of logio CFU per milliliter of 1.6 ± 0.05) (P < 0.001). When bactericidal synergism can be demonstrated for mecillinam-ampicillin in vitro in a case of gram-negative-bacillary meningitis this combination may be useful in the therapy of the illness.

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mentioning

confidence: 99%

Mecillinam-Ampicillin Synergism in Experimental Enterobacteriaceae Meningitis

Scheld

Fink

Fletcher

et al. 1979

Antimicrob Agents Chemother

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“…Antibiotic therapy would then be changed accordingly and intrathecal methicillin 25 mg daily would be given for staphylococcal infection, and penicillin 686 Six of the 16 infants with Gram-negative infections were found to have ventriculitis (Lorber et al, 1970;Salmon, 1972) and were treated with daily intraventricular antibiotics (Table II). Cases 3 and 7 had meningitis for 14 and 5 days respectively before admission and were partially treated with antibiotics, Case 3 having also received two intrathecal gentamicin injections.…”

Section: Methodsmentioning

confidence: 99%

“…Intraventricular antibiotics were given to the other infants because of signs of ventriculitis (Lorber et al, 1970;Salmon, 1972) and failure of lumbar intrathecal therapy to sterilize the CSF in 2-3 days. 2 of the 4 infants with Gram-positive infections were also treated with intraventricular antibiotics.…”

Section: Methodsmentioning

confidence: 99%

“…Two recent reports from South Africa (MacDonald, 1972) and Montreal (Fitzhardinge et al, 1974) still show a mortality of 50% and 44% respectively. Persistent ventriculitis has been implicated as the cause of treatment failure in many cases of neonatal meningitis (Lorber, Kalhan, and Mahgrefte, 1970;Salmon, 1972;Moellering and Fischer, 1972). Many workers (Stark, 1968;Lorber et al, 1970;Salmon, 1972;Moellering and Fischer, 1972) have suggested that the level of antibiotics in the ventricular CSF is an important prognostic factor in treatment.…”

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confidence: 99%

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Intrathecal antibiotic therapy for neonatal meningitis.

Yeung¹

1976

Archives of Disease in Childhood

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“…Atraumatic intranasal inoculation is followed by bacteremia and meningitis (22). Choroid plexitis, ventricular infection, and other histopathological features of meningitis in infant monkeys (6) are also present in human infants with meningitis caused by enteric gramnegative bacilli (1,2,9,12,21).Using this model, we sought to optimize the penetration of gentamicin into CSF by testing the hypothesis that a high concentration of drug in serum would facilitate ingress into CSF. To do this, we measured the gentamicin concentration in CSF after intramuscular injection, slow intravenous itifusion, or intravenous bolus administration in normal subhuman primnates and those with H. influenzae meningitis.…”

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confidence: 99%

Gentamicin penetration into cerebrospinal fluid in experimental Haemophilus influenzae meningitis

Smith

Daum

Siber

et al. 1988

Antimicrob Agents Chemother

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We studied the effect of meningitis and the method of parenteral gentamicin administration (intramusclar injection, a 30-min intravenous infusion, or intravenous bolus administration) on achievable concentrations of drug in cerebrospinal fluid (CSF). In normal animals, only intravenous bolus administration of 2 to 8 mg/kg produced a gentamicin concentration of >0.1 rg/ml in CSF in some aninalsg. All CSF samples contained less than the limit of detection (0.1 ,ug/ml) after the intramuscular administration of 6 mg/kg. In animals with meningitis, gentamicin penetration into cisternal CSF was increased significantly after a bolus administration of 6 mg/kg (mean, 0.197 ± 0.063 ,ug/ml in normal animals versus 1.68 ± 0.38 ,ug/ml in animals with meningitis; P < 0.01). In meningitic animals that received 6 mg/kg as an intravenous bolus, lumbar CSF had the highest maximum concentration (4.25 ± 1.08 pg/ml), in comparison with ventricular CSF (3.10 ± 0.66 "g/ml). The gentamicin concentration in cisternal CSF decreased more slowly than it did in serum (elimnnation half-life, 238.70 ± 64.56 min in cisternal CSF versus 82.73 ± 2.91 min in serum), yielding a relative increase in the percentage of penetration. We conclude that maximum penetration by gentamicin into CSF occurs after intravenous bolus administration and that the maximum concentration occurs in lumbar CSF.Meningitis caused by gram-negative organisms remains a major therapeutic challenge; mortality from this disease ranges from between 12 and 75% (8, 15, 16). Aminoglycosides administered parenterally are often used to treat this disease (11,14), although these antibiotics may penetrate the blood-brain barrier poorly. A favorable outcome in patients with meningitis infected with members of the family Enterobacteriaceae treated with aminoglycosides has been related to concomitant therapy with another effective antimicrobial agent, usually a beta-lactam (5, 16).Data on the penetration of gentamicin into cerebrospinal fluid (CSF) in humans following parenteral administration are fragmentary. Gentamicin concentrations in lumber CSF were measured by an radioenzymatic assay on four occasions in three neonates with gram-negative bacillary meningitis following a 2.5-mg/kg dose of gentamicin administered as an infusion over 30 min (5). Gentamicin was detectable (>1.0 ,xg/ml) in one of four CSF specimens. By a similar assay technique, no gentamicin could be detected in ventricular CSF of four hydrocephalic patients with ventriculitis following an intravenous infusion of undefined duration (20). Moellering and Fischer (17) measured gentamicin concentrations in lumbar CSF by using a microbiological assay in a 17-month-old child with meningitis. CSF concentrations of 0.5 and 0.3 ,ug/ml were observed 4 and 5 h, respectively, following an intramuscular dose of 2 mg/kg.In contrast to these results that indicated that aminoglycoside penetrated poorly, Eichenwald (7) tion of 1.6 ,ug/ml (range, 0.3 to 3.7 ,ug/ml) in lumbar CSF in 43 infants with gram-negative enteric meningitis, foll...

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Ventriculitis Complicating Meningitis

Cited by 51 publications

References 10 publications

Mecillinam-Ampicillin Synergism in Experimental Enterobacteriaceae Meningitis

Mecillinam-Ampicillin Synergism in Experimental Enterobacteriaceae Meningitis

Intrathecal antibiotic therapy for neonatal meningitis.

Gentamicin penetration into cerebrospinal fluid in experimental Haemophilus influenzae meningitis

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