Intraventricular chemotherapy in neonatal meningitis

Lee, E.L.; Robinson, M. J.; Thong, M L; Puthucheary, S. D.; Ong, T. H.; Ng, Kkc

doi:10.1016/s0022-3476(77)80913-x

Cited by 80 publications

(32 citation statements)

References 15 publications

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“…Most cases of neonatal or postneurosurgical meningitis are now caused by the Enterobacteriaceae or Pseudomonas (7,9,11). The mortality rate and frequency of neurological sequelae remain high (2,17).…”

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confidence: 99%

“…The aminoglycosides are now considered the drugs of choice for gramnegative-bacillary meningitis, but their low therapeutic index and poor penetration into the CSF have necessitated direct instillation of these drugs into the CSF by either the lumbar or the ventricular route. The high rate of ventriculitis in these infections, especially in neonatal meningitis (3,9), and the inability of gentamicin to reach ventricular sanctuaries of bacteria after intralumbar administration (8) have favored the intraventricular route. This mode of therapy notwithstanding, the mortality and complication rates remain high (13).…”

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confidence: 99%

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Mecillinam-Ampicillin Synergism in Experimental Enterobacteriaceae Meningitis

Scheld

Fink

Fletcher

et al. 1979

Antimicrob Agents Chemother

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The in vitro activities of mecillinam, a new f)-amidinopenicilhin, and ampicillin, alone and in combination, against an Escherichia coli strain and a Klebsiella pneumoniae strain were compared, and these results were correlated with their respective activities in vivo in experimental meningitis. The mecillinam-ampicillin combination was synergistic in vitro against both strains when tested by a modified checkerboard technique (bacteriostatic synergy). However when quantitative bactericidal synergy studies were made, the relative bactericidal rate of the combination was more rapid than that of either drug alone ("bactericidal synergy") against the Escherichia coli isolate only. In a rabbit model of Enterobacteriaceae meningitis, in vivo bactericidal activity correlated with results obtained in vitro. Both drugs were administered by continuous intravenous infusion for 8 h. Serum and cerebrospinal fluid antibiotic levels were similar to those achieved in humans. Cerebrospinal fluid bacterial concentrations (colonyforming units [CFU] per milliliter) were quantitatively titrated at 2-h intervals. Both drugs, alone or the combination, were ineffective against the K. pneumoniae strain in vivo (change in titer <1 log in 8 h). In contrast, the combination produced a markedly enhanced bactericidal effect against the E. coli strain (mean + standard deviation, decrease of log1o CFU per milliliter of 3.65 ± 1.02) compared with those of ampicillin alone (decrease of log1o CFU per milliter of 0.07 ± 0.8) and mecillinam alone (decrease of logio CFU per milliliter of 1.6 ± 0.05) (P < 0.001). When bactericidal synergism can be demonstrated for mecillinam-ampicillin in vitro in a case of gram-negative-bacillary meningitis this combination may be useful in the therapy of the illness.

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confidence: 99%

mentioning

confidence: 99%

Mecillinam-Ampicillin Synergism in Experimental Enterobacteriaceae Meningitis

Scheld

Fink

Fletcher

et al. 1979

Antimicrob Agents Chemother

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“…MRI is more specific and more sensitive than CT for diagnosis (14). Treatment of ventriculitis complicating bacterial meningitis is pursuant to bacterial meningitis treatment, which requires prompt and adequate antibiotic administration; however, the duration of antibiotic treatment has not been clearly determined and treatment occasionally requires intraventricular chemotherapy (13). The present case was successfully treated by extending the period of antibiotic administration for 21 days, until patient's improvement was determined using both CSF findings and MRI imaging.…”

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confidence: 87%

“…Ventriculitis is uncommon in adults, while it has been reported as a frequent complication of bacterial meningitis in neonates with greater morbidity and mortality rates (12,13). Thus, early and accurate diagnosis is necessary.…”

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confidence: 99%

“…Berman et al performed a pathological study at autopsy following neonatal bacterial meningitis and revealed that 21 of 25 neonates had ventriculitis (12). Lee et al reported that meningitis in all of the 16 newborns examined was accompanied by ventriculitis at the time of the initial ventricular puncture (13). Ventriculitis is usually considered when bacterial meningitis shows poor response to appropriate antibiotics, or when hydrocephalus is diagnosed using brain imaging.…”

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Unexpected Ventriculitis Complication of Neonatal Meningitis Caused by <i>Streptococcus gallolyticus</i> Subsp. <i>pasteurianus</i>: a Case Report

et al. 2018

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Streptococcus gallolyticus subsp. pasteurianus, previously known as S. bovis biotype II 2, belongs to the S. bovis group and is an uncommon cause of neonatal bacterial meningitis (1). Over the last 2 decades, this pathogen is increasingly recognized as a cause of meningitis and bacteremia in young infants; however, its clinical significance has not been well established. Here, we report a case of neonatal meningitis that was unexpectedly complicated by ventriculitis due to this pathogen and review the relevant literature.A male infant was born by spontaneous vaginal delivery at term, weighing 3,680 g. Pregnancy and labor were uneventful. The patient developed fever (39 C) when he was 27 days old. Next day, he was admitted to the hospital with peripheral coldness, tachycardia, facial pallor, lethargy, and irritability. His anterior fontanel was not distended. Blood examination showed the following results: leukocyte count 17,380 mm 3 (64.5 segmented neutrophils, 18 bands); C-reactive protein 7.86 mg dL; procalcitonin 23.32 ng mL. The cerebrospinal fluid (CSF) was cloudy with leukocyte count at 7,909 mm 3 (97 polymorphonuclear cells), protein levels at 214 mg dL, and glucose levels at 1 mg dL (blood glucose 112 mg dL). Latex antigen tests were negative for Haemophilus influenzae type b, Neisseria meningitidis, Escherichia coli, group B Streptococcus (GBS) and

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