RANDOMIZED COMPARISON OF MEROPENEM WITH CEFOTAXIME FOR TREATMENT OF BACTERIAL-MENINGITIS

Broad-spectrum cephalosporins are drugs of choice for the treatment of meningitis in communities which can afford them. The emergence of cep halosporin-resistant pneumococci demands the clinical trial of alterna te agents. Carbapenems are active against the bacteria causing meningi tis, but the use of imipenem-cilastatin was frustrated by drug-associa ted 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 2 4 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 occu rred during therapy in 5 of 82 patients (6%) receiving meropenem and i n 1 of 86 patients (1%) receiving cefotaxime (95% confidence interval: -0.7%, 10.6%). None were thought to be drug related. Twenty-four mero penem-treated patients (24%) and 11 cefotaxime-treated patients (12%) had neurological abnormalities before therapy. In patients without pre therapy neurological abnormalities, these abnormalities were present a fter 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, respectiv ely, had repeat lumbar punctures. Bacterial eradication was found to b e 100% in both groups. Our data suggest that meropenem may be a carbap enem agent that is well tolerated and effective in the treatment of ba cterial meningitis.