CEFTRIAXONE THERAPY OF BACTERIAL-MENINGITIS - CEREBROSPINAL-FLUID CONCENTRATIONS AND BACTERICIDAL ACTIVITY AFTER INTRAMUSCULAR INJECTION INCHILDREN TREATED WITH DEXAMETHASONE

Antibiotic therapy is administered intravenously to children with bact erial meningitis to achieve the highest possible blood and cerebrospin al fluid (CSF) concentrations. However, intravenous access for the ent ire duration of therapy may be difficult in some children. Intramuscul ar therapy offers a more versatile option; however, CSF concentrations and bactericidal activity following im injection in children concurre ntly treated with dexamethasone have not been studied. We prospectivel y evaluated 37 children given an im dose of ceftriaxone on either the 3rd, 6th or 9th day of antibiotic therapy while receiving dexamethason e for the first 4 days of treatment. All children were required to hav e normal peripheral perfusion at the time of im injection, Four to 6 h ours after im injection CSF was obtained. The average age of study pat ients was 28 months; Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type b were responsible for 95% of all infe ctions. Al children studied had detectable CSF ceftriaxone concentrati ons, with mean (+/- SD) concentrations (mu g/ml) on Days 3, 6 and 9 of therapy of 5.7 +/- 5.5 (n = 12), 5.2 +/- 5.0 (n = 14) and 2.0 +/- 2.6 (n = 10), respectively. All CSF bactericidal titers for N. meningitid is, S. pneumoniae and H. influenzae type b, regardless of day of im in jection, were greater than or equal to 1:64. Intramuscular ceftriaxone therapy of bacterial meningitis may be a reasonable therapeutic optio n for the convalescing child with good peripheral perfusion.