Randomized trial of four vs. seven days of ceftriaxone treatment for bacterial meningitis in children with rapid initial recovery

Background. Seven days or more of antimicrobial treatment is the standard f or bacterial meningitis, although third generation cephalosporins are usual ly able to sterilize cerebrospinal fluid within 24 h, The limited experienc e from shorter regimens in children is encouraging, and we hypothesized tha t in rapidly recovering patients older than 3 months of age it would pose n o risk for adverse outcome. Methods. Strict clinical and laboratory criteria were used to define rapid initial recovery, in which case ceftriaxone therapy was either stopped afte r 4 days (4 injections) in children born on even dates (N = 53) or continue d for 7 days in patients born on odd dates (N = 47). Outcomes were compared on Day 7 of hospitalization and at 1 to 3 months after discharge, Results. On Day 7 no differences (P > 0.05 for each criteria) were observed between the 4-day and the 7-day groups regarding fever, clinical signs or serum C-reactive protein concentration. At the follow-up visit 1 to 3 month s after discharge the 4-day group had fewer sequelae than the 7-day group ( 0% vs. 5% neurologic sequelae, P = 0.39 and 3% vs. 9% hearing loss, P = 0.4 9, respectively), One child in the 4-day group who had fully recovered was subsequently readmitted 53 days after the first hospitalization with recurr ent Haemophilus influenzae meningitis. Conclusions. Four days of ceftriaxone therapy proved to be a safe alternati ve in patients with rapid initial recovery from bacterial meningitis, A 4-d ay course of treatment is particularly beneficial for countries with limite d resources.