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Successful treatment of meningitis with cefotaxime in an adult
Journal of Infection (1983) 7, 270-271
CASE REPORT Successful
treatment
of meningitis
with cefotaxime
in an adult
D. K. Jones* a n d A. R. L u k s z a
Intensive Care Unit and Clinical Research Laboratory, Whiston Hospital, Prescot, Merseyside L35 5DR Accepted for publication 15 April 1983 Summary A case of severe bacterial meningitis complicated by alcoholism, lobar pneumonia and coma, is described. Although triple antibiotic therapy had been ineffective, the patient made a rapid and complete recovery when treated with cefotaxime alone.
Introduction T h e successful treatment of childhood and neonatal meningitis with cefotaxime has been well-documented. 1 We report a case of severe bacterial meningitis, in an adult, which had failed to respond to conventional antimicrobial therapy. T h e introduction of cefotaxime led to a dramatic and full recovery.
Case report A 5I-year-old man, a heavy drinker, was admitted to hospital in a toxic confusional state. Four days earlier he had suffered with an influenza-like illness for which antibiotics had been prescribed by his General Practitioner. On examination he was confused, drowsy and salt-depleted. He had tachypnoea, fever of 37"8 °C and signs of left lower lobe pneumonic consolidation. His white blood cell count was 21.2 × IO9/1, his blood urea was lO-8 mmol/1 and a chest radiograph confirmed left lower lobe pneumonia. Ampicillin 500 mg and flucloxacillin 500 mg were given intravenously every six hours. During the next 36 hours the patient's condition became worse with loss of consciousness and his temperature rose to 39 °C. A lumbar puncture revealed turbid cerebrospinal fluid (CSF) containing 25 × lO9/1 white cells, 95 per cent of which were neutrophils. A gram-stained film and bacterial culture were both negative. Treatment was changed to benzyl penicillin 2 mega units, suphadimidine I g and chloramphenicol I g, all given every six hours intravenously. His condition continued to deteriorate and after three doses of the triple antibacterial therapy, he was assessed on the Glasgow Coma Scale 2 as best motor response I, best verbal response I, and best eye opening I. T h e triple therapy was discontinued and cefotaxime 4 g 8-hourly was substituted. Twelve hours later his temperature returned to normal and his state of consciousness improved. He was discharged from hospital a week later after Present address: Papworth Hospital, Papworth Everard, Cambridge CB3 8RE.
o163-4453/83/o6o27o + 02 $o2.oo/o
© I983 The British Society for the Study of Infection
Bacterial meningitis and cefotaxime
271
6 days of cefotaxime treatment. T w o m o n t h s after discharge f r o m hospital he was completely well. Comment T h e association of alcoholism, lobar p n e u m o n i a and bacterial meningitis suggested that the likely organism in this case was Streptococcus pneumoniae. Failure to find the organism was probably due to the previous antimicrobial therapy. M o r t a l i t y in pneumococcal meningitis is about 20 per cent and even higher in the presence of another focus of infection elsewhere, alcoholism and coma. 3 T h e recovery of this patient following the introduction of cefotaxime w h e n more o r t h o d o x therapy had failed suggests that this drug is effective in bacterial meningitis in an adult. Cefotaxime is a t h i r d generation cephalosporin with a wide range of activity against G r a m - n e g a t i v e and Gram-positive organisms. Its use in neonatal and childhood meningitis has been well d o c u m e n t e d but controlled studies have not apparently been done among adult patients. As cefotaxime diffuses into the C S F in bacterial meningitis in sufficient concentrations to inhibit most of the causative organisms 4 it should be considered as an alternative drug for use in the ' b l i n d ' t r e a t m e n t of bacterial meningitis. References i. Young JPW, Husson JM, Bruch K, Blamer RJ, Savopoutos C. The evaluation of efficacy and safety of cefotaxime: a review of 2500 cases. J Antimicrob Chemother I98O; 6 Suppl A: 293-300. 2. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. Lancet I974; ii: 81-83. 3. Swartz MN. Bacterial meningitis. In: Beeson PB, McDermott W, Wyngaarden JB, eds. Cecil: Textbook of Medicine. Philadelphia: Saunders WB, I979: 4I 1-416. 4. Belohradsky BH, Geiss D, Margret W, Bruch K, Kafetzis D, Peters G. Intravenous cefotaxime in children with bacterial meningitis. Lancet I98o; i: 61-63.
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CASE REPORT Successful
treatment
of meningitis
with cefotaxime
in an adult
D. K. Jones* a n d A. R. L u k s z a
Intensive Care Unit and Clinical Research Laboratory, Whiston Hospital, Prescot, Merseyside L35 5DR Accepted for publication 15 April 1983 Summary A case of severe bacterial meningitis complicated by alcoholism, lobar pneumonia and coma, is described. Although triple antibiotic therapy had been ineffective, the patient made a rapid and complete recovery when treated with cefotaxime alone.
Introduction T h e successful treatment of childhood and neonatal meningitis with cefotaxime has been well-documented. 1 We report a case of severe bacterial meningitis, in an adult, which had failed to respond to conventional antimicrobial therapy. T h e introduction of cefotaxime led to a dramatic and full recovery.
Case report A 5I-year-old man, a heavy drinker, was admitted to hospital in a toxic confusional state. Four days earlier he had suffered with an influenza-like illness for which antibiotics had been prescribed by his General Practitioner. On examination he was confused, drowsy and salt-depleted. He had tachypnoea, fever of 37"8 °C and signs of left lower lobe pneumonic consolidation. His white blood cell count was 21.2 × IO9/1, his blood urea was lO-8 mmol/1 and a chest radiograph confirmed left lower lobe pneumonia. Ampicillin 500 mg and flucloxacillin 500 mg were given intravenously every six hours. During the next 36 hours the patient's condition became worse with loss of consciousness and his temperature rose to 39 °C. A lumbar puncture revealed turbid cerebrospinal fluid (CSF) containing 25 × lO9/1 white cells, 95 per cent of which were neutrophils. A gram-stained film and bacterial culture were both negative. Treatment was changed to benzyl penicillin 2 mega units, suphadimidine I g and chloramphenicol I g, all given every six hours intravenously. His condition continued to deteriorate and after three doses of the triple antibacterial therapy, he was assessed on the Glasgow Coma Scale 2 as best motor response I, best verbal response I, and best eye opening I. T h e triple therapy was discontinued and cefotaxime 4 g 8-hourly was substituted. Twelve hours later his temperature returned to normal and his state of consciousness improved. He was discharged from hospital a week later after Present address: Papworth Hospital, Papworth Everard, Cambridge CB3 8RE.
o163-4453/83/o6o27o + 02 $o2.oo/o
© I983 The British Society for the Study of Infection
Bacterial meningitis and cefotaxime
271
6 days of cefotaxime treatment. T w o m o n t h s after discharge f r o m hospital he was completely well. Comment T h e association of alcoholism, lobar p n e u m o n i a and bacterial meningitis suggested that the likely organism in this case was Streptococcus pneumoniae. Failure to find the organism was probably due to the previous antimicrobial therapy. M o r t a l i t y in pneumococcal meningitis is about 20 per cent and even higher in the presence of another focus of infection elsewhere, alcoholism and coma. 3 T h e recovery of this patient following the introduction of cefotaxime w h e n more o r t h o d o x therapy had failed suggests that this drug is effective in bacterial meningitis in an adult. Cefotaxime is a t h i r d generation cephalosporin with a wide range of activity against G r a m - n e g a t i v e and Gram-positive organisms. Its use in neonatal and childhood meningitis has been well d o c u m e n t e d but controlled studies have not apparently been done among adult patients. As cefotaxime diffuses into the C S F in bacterial meningitis in sufficient concentrations to inhibit most of the causative organisms 4 it should be considered as an alternative drug for use in the ' b l i n d ' t r e a t m e n t of bacterial meningitis. References i. Young JPW, Husson JM, Bruch K, Blamer RJ, Savopoutos C. The evaluation of efficacy and safety of cefotaxime: a review of 2500 cases. J Antimicrob Chemother I98O; 6 Suppl A: 293-300. 2. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. Lancet I974; ii: 81-83. 3. Swartz MN. Bacterial meningitis. In: Beeson PB, McDermott W, Wyngaarden JB, eds. Cecil: Textbook of Medicine. Philadelphia: Saunders WB, I979: 4I 1-416. 4. Belohradsky BH, Geiss D, Margret W, Bruch K, Kafetzis D, Peters G. Intravenous cefotaxime in children with bacterial meningitis. Lancet I98o; i: 61-63.
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