A RANDOMIZED COMPARISON OF MEROPENEM WITH CEFOTAXIME OR CEFTRIAXONE FOR THE TREATMENT OF BACTERIAL-MENINGITIS IN ADULTS

Third-generation cephalosporins are presently the agents of choice for the empirical antimicrobial therapy of bacterial meningitis. However, a number of factors associated with these agents, namely the developm ent of resistance by pneumococci, limited activity against some Entero bacteriaceae and Pseudomonas spp., and the possible adverse effects of their bacteriolytic mode of action, indicate that newer classes of an timicrobial agents be evaluated for the treatment of bacterial meningi tis. Meropenem is a carbapenem antibiotic which is highly active again st the major bacterial pathogens causing meningitis, and penetrates we ll into the cerebrospinal fluid. Two prospective randomised studies in 56 adult bacterial meningitis patients have compared meropenem 40 mg/ kg 8-hourly, up to a maximum of 6 g/day (n = 28) with cephalosporin tr eatment, i.e. cefotaxime (n = 17) or ceftriaxone (n = 11). Patients we re assessed by neurological examination, Glasgow Coma Score and Herson -Todd score. Clinical cure was observed in all 23 evaluable patients t reated with meropenem (100%) and with 17 of the 22 evaluable cephalosp orin-treated patients (77 %). All pre-treatment isolates were eradicat ed except one isolate of Staphylococcus aureus in a cefotaxime-treated patient. Neurological sequelae were noted in three meropenem and four cephalosporin-treated patients. No patients in either treatment group experienced seizures after the start of therapy. This was despite the fact that a patient in each group had experienced seizures before the rapy, several had underlying CNS disorders, and that doses of 6 g/day of meropenem were given. Hearing impairment was recorded in 11 meropen em and nine cephalosporin treated patients. Three patients in the mero penem group and one in the cephalosporin group died during treatment f or reasons unrelated to study therapy. Overall, the results of this st udy indicate that meropenem is an effective and well-tolerated antibio tic for the treatment of bacterial meningitis in adults.