PEDIATRICS Vol. 81 No. 6 June 1988, pp. 904-907
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Treatment of Bacterial Meningitis

Committee on Infectious Diseases

The purpose of this report is to review the evidence for efficacy of the new cephalosporin compounds and to provide a basis for determining the most appropriate initial empiric regimen for treating bacterial meningitis in infants and children. For a more complete discussion concerning diagnosis and management of meningitis, the reader is referred to a recently published report by a task force appointed by the American Academy of Pediatrics.1 This report, however, goes beyond that of the task force by indicating the new cephalosporins as first-line drugs for therapy and by recommending shorter duration of treatment for some patients with meningitis. This report will also address the issue of alternative treatment regimens that might facilitate more rapid discharge from the hospital, less costly management, and home care of some patients with meningitis.

BACKGROUND

New Cephalosporins

Initial empiric antimicrobial therapy for bacterial meningitis entails selection of antibiotics that are effective against the likely etiologic agents and use of proper drug dosages and administration schedules that result in adequate bactericidal activity in CSF. In newborn infants, the initial empiric regimen conventionally used has been ampicillin and an aminoglycoside. In older infants and children, ampicillin and chloramphenicol have been used for more than a decade. The newer cephalosporins (ie, cefuroxime, moxalactam, cefotaxime, ceftriaxone, and ceftazidime) have been evaluated in controlled, prospective studies. Despite their superior in vitro activity against the common meningeal pathogens and greater bactericidal activity in CSF, those cephalosporins do not sterilize CSF cultures more rapidly or improve case-fatality rates when compared with results of conventional antibiotic regimens in neonates2 or in infants and children.3-10




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