The Treatment of Pneumococcic Meningitis With Massive Doses of Systemic Penicillin

Dowlinc, Harry F.; Sweet, Lewis K.; Robinson, Jay A.; Zellers, William W.; Hirsh, Harold L.

doi:10.1097/00000441-194902000-00005

Cited by 62 publications

(6 citation statements)

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“…2 For the past 15 years, therapy for communityacquired bacterial meningitis has consisted of intravenous penicillin (or ampicillin), a third-generation cephalosporin, or both; mortality rates for meningococcal meningitis have hovered around 10 percent, those for H. influenzae meningitis have been reduced to less than 5 percent, and those for pneumococcal meningitis have remained around 20 percent. Modern treatment with "meningeal" doses without concomitant intrathecal drug administration began with the 1949 report by Dowling et al of a study in which 21 patients with pneumococcal meningitis were treated with 1 million units of penicillin intramuscularly every two hours, with a resulting improvement in mortality to 38 percent.…”

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confidence: 99%

Bacterial Meningitis — A View of the Past 90 Years

Swartz

2004

N Engl J Med

174

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confidence: 99%

Bacterial Meningitis — A View of the Past 90 Years

Swartz

2004

N Engl J Med

174

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“…In the 1920s and 1930s it was also recognized that somatic antigens of pneumococci could elicit protective immune responses (20,23). In spite of the development of a pneumococcal vaccine based on the capsular polysaccharides (3) and the susceptibility of pneumococci to penicillin (19), pneumococcal infection has remained serious in both developed and underdeveloped countries (33, 36). The renewed awareness of the continuing morbidity and mortality resulting from pneumococcal infections (4, 33) has encouraged many laboratories to extend earlier studies of pathogenic mechanisms of pneumococci and host defenses against pneumococcal infection.…”

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Mouse antibody to phosphocholine can protect mice from infection with mouse-virulent human isolates of Streptococcus pneumoniae

1992

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Previous studies have demonstrated that mouse antibodies to phosphocholine (PC) can protect mice against fatal infection caused by several, but not all, mouse-virulent laboratory strains of Streptococcus pneumoniae. Because the pneumococcal strains used in previous studies had been mouse passed and were propagated for many years outside of humans, it was not known whether antibody to PC would be able to protect mice against S. pneumoniae freshly isolated from humans. In the present study, we examined the ability of an immunoglobulin G (IgG) monoclonal antibody (MAb) to PC to protect against infections in mice caused by 14 pneumococcal strains of capsular types 3, 4, 6A, and 6B. Nine of these strains were selected as the most virulent strains for mice from a group of 69 fresh clinical isolates. Five were mouse-passed laboratory strains. Mouse IgG3 MAb to PC was able to exhibit protective effects (survival or increased time to death) against infection with virtually all of the strains injected intravenously and against infection with 70% of the strains injected intraperitoneally. The protective effects of antibody to PC appeared to be partially dependent on capsular type. MAb to PC was most effective against capsular type 3 strains and least effective against type 4 strains. With type 3 and type 4 strains, MAb to PC could frequently protect against larger numbers of CFU injected intravenously than intraperitoneally. For capsular type 6A and 6B strains the reverse was true.

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“…By the 1950s, the combined use of sulfonamides (meningococcus, Haemophilus influezae ), chloramphenicol ( H. influenzae ), and high dose penicillin (pneumococcus) as standard therapies decreased the case fatality rate to single digits for H. influenzae and meningococcus . Yet, the fatality rate after pneumococcal meningitis remained close to 40% …”

Section: Acute Bacterial Meningitis: Pneumococcus Stands Out As a Tre...mentioning

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Acute Bacterial Meningitis: Challenges to Better Antibiotic Therapy

Kietzman

Tuomanen

2019

ACS Infect. Dis.

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Bacterial meningitis is a medical emergency requiring highly bactericidal antibiotics to achieve cure. Many challenges exist to achieving optimal patient outcome. First, antibiotics must pass the blood brain barrier. Once in the subarachnoid space, achieving bactericidal therapy involves circumventing antibiotic resistance and, more commonly, antibiotic tolerance arising from the slow growth of bacteria in the nutrient poor cerebrospinal fluid. Finally, bactericidal therapy is most often bacteriolytic, and debris from lysis is highly inflammatory. Controlling damage from lytic products may require adjunctive therapy to prevent neuronal death. These challenges are an extreme example of the different requirements for treating infections in different body sites.

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The Treatment of Pneumococcic Meningitis With Massive Doses of Systemic Penicillin

Cited by 62 publications

References 0 publications

Bacterial Meningitis — A View of the Past 90 Years

Bacterial Meningitis — A View of the Past 90 Years

Mouse antibody to phosphocholine can protect mice from infection with mouse-virulent human isolates of Streptococcus pneumoniae

Acute Bacterial Meningitis: Challenges to Better Antibiotic Therapy

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