Randomized comparison of meropenem with cefotaxime for treatment of bacterial meningitis

K. P. Klugman, R. Dagan, K. J. Williams, A. Featherstone, D. Beatty, M. Leary, K. Walker, J. Rodda, G. Scher, C. Househam, H. Pelsar, E. Lopez, L. Fallo, M. W. Tregnaghi, A. Aird, E. Q. De Apra, P. Begue, J. Boulesteix, D. Florel

Research output: Contribution to journalArticlepeer-review

148 Scopus citations

Abstract

Broad-spectrum cephalosporins are drugs of choice for the treatment of meningitis in communities which can afford them. The emergence of cephalosporin-resistant pneumococci demands the clinical trial of alternate agents. Carbapenems are active against the bacteria causing meningitis, but the use of imipenem-cilastatin was frustrated by drug-associated seizures. The safety and efficacy of meropenem, a new carbapenem, were compared to those of cefotaxime in a prospective randomized trial of 190 children with bacterial meningitis. Seizures occurred within 24 h before antibiotic therapy in 16 of 98 patients (16%) randomized to receive meropenem and in 6 of 92 patients (7%) randomized to receive cefotaxime. In patients without seizures before therapy, seizures occurred during therapy in 5 of 82 patients (6%) receiving meropenem and in 1 of 86 patients (1%) receiving cefotaxime (95% confidence interval: -0.7%, 10.6%). None were thought to be drug related. Twenty-four meropenem-treated patients (24%) and 11 cefotaxime-treated patients (12%) had neurological abnormalities before therapy. In patients without pretherapy neurological abnormalities, these abnormalities were present after treatment in 4 of 74 meropenem-treated patients (5%) and in 2 of 81 cefotaxime-treated patients (2%) (95% confidence interval: -3.2%, 9.1%). Of 75 meropenem-treated and 64 cefotaxime-treated patients with pretherapy positive cerebrospinal-fluid cultures, 68 and 59, respectively, had repeat lumbar punctures. Bacterial eradication was found to be 100% in both groups. Our data suggest that meropenem may be a carbapenem agent that is well tolerated and effective in the treatment of bacterial meningitis.

Original languageEnglish
Pages (from-to)1140-1146
Number of pages7
JournalAntimicrobial Agents and Chemotherapy
Volume39
Issue number5
DOIs
StatePublished - 1 Jan 1995
Externally publishedYes

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Fingerprint

Dive into the research topics of 'Randomized comparison of meropenem with cefotaxime for treatment of bacterial meningitis'. Together they form a unique fingerprint.

Cite this