Risk/Benefit in the Treatment of Children with Imipenem-Cilastatin for Meningitis Caused by Penicillin-Resistant Pneumococcus

Asensi, F; Otero, M. C.; Pérez-Tamarit, D; Rodríguez-Escribano, I; Cabedo, J L; Gresa, S; Cantón, Emilia

doi:10.1080/1120009x.1993.11739221

Cited by 36 publications

(5 citation statements)

References 4 publications

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“…Adverse events considered related to the study drugs were observed in 14 of 190 patients (5 given meropenem [5.1%] and 9 given cefotaxime [9.8%]). In the meropenem group there were single episodes of thrombocythemia, oral moniliasis, diarrhea, rash, and fever, and in the cefotaxime group, there were episodes of oral moniliasis (6), diarrhea (2), and eosinophilia (1).…”

Section: Resultsmentioning

confidence: 99%

Randomized comparison of meropenem with cefotaxime for treatment of bacterial meningitis. Meropenem Meningitis Study Group

Klugman

Dagan

1995

Antimicrob Agents Chemother

159

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Broad-spectrum cephalosporins are drugs of choice for the treatment of meningitis in communities which can afford them. The emergence of cephalosporin-resistant pneumococci demands the clinical trial of alternate agents. Carbapenems are active against the bacteria causing meningitis, but the use of imipenem-cilastatin was frustrated by drug-associated 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 24 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 occurred during therapy in 5 of 82 patients (6%) receiving meropenem and in 1 of 86 patients (1%) receiving cefotaxime (95% confidence interval: ؊0.7%, 10.6%). None were thought to be drug related. Twenty-four meropenem-treated patients (24%) and 11 cefotaxime-treated patients (12%) had neurological abnormalities before therapy. In patients without pretherapy neurological abnormalities, these abnormalities were present after 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, respectively, had repeat lumbar punctures. Bacterial eradication was found to be 100% in both groups. Our data suggest that meropenem may be a carbapenem agent that is well tolerated and effective in the treatment of bacterial meningitis.

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Section: Resultsmentioning

confidence: 99%

Randomized comparison of meropenem with cefotaxime for treatment of bacterial meningitis. Meropenem Meningitis Study Group

Klugman

Dagan

1995

Antimicrob Agents Chemother

159

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“…The second case report involved an 18-month-old treated with imipenem/cilastatin at a dose of 100 mg/kg/day after failure of other antibiotics [12]. The authors report a generalized tonic-clonic seizure on day 9 of therapy that ceased when 3 mg of diazepam were administered.…”

Section: Literature Reviewmentioning

confidence: 99%

Safety of Imipenem/Cilastatin in Neurocritical Care Patients

2008

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“…Furthermore, animal studies have shown that when used in conjunction with dexamethasone, vancomycin's penetration into the CSF is decreased even further [21]. While imipenem is an effective alternative for treating penicillin-resistant pneumococcal meningitis, it also carries the risk of seizures, especially in the setting of renal insufficiency [22]. Meropenem has shown some activity against this organism, but further experience is needed before recommendations can be made regarding its routine use in this setting [23].…”

Section: Choice Of Empiric Antibioticsmentioning

confidence: 99%

Bacterial meningitis: Principles and practical aspects of therapy

Aronin

2000

Curr Infect Dis Rep

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Acute bacterial meningitis continues to be associated with significant morbidity and mortality. Recent research efforts to improve outcome for such patients have focused on antibiotic-cerebrospinal fluid interactions, factors influencing antibiotic selection, indications for cranial imaging, the role of anti-inflammatory agents, and the impact of antibiotic timing on outcome. In this article, I use an illustrative case to review timely data on these topics and provide guidelines for the empiric and pathogen-directed treatment of patients with acute bacterial meningitis.

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Risk/Benefit in the Treatment of Children with Imipenem-Cilastatin for Meningitis Caused by Penicillin-Resistant Pneumococcus

Cited by 36 publications

References 4 publications

Randomized comparison of meropenem with cefotaxime for treatment of bacterial meningitis. Meropenem Meningitis Study Group

Randomized comparison of meropenem with cefotaxime for treatment of bacterial meningitis. Meropenem Meningitis Study Group

Safety of Imipenem/Cilastatin in Neurocritical Care Patients

Bacterial meningitis: Principles and practical aspects of therapy

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