Long-acting chloramphenicol versus intravenous ampicillin for treatment of bacterial meningitis.

Hdl Handle:
http://hdl.handle.net/10144/19393
Title:
Long-acting chloramphenicol versus intravenous ampicillin for treatment of bacterial meningitis.
Authors:
Pécoul, B; Varaine, F; Keita, M; Soga, G; Djibo, A; Soula, G; Abdou, A; Etienne, J; Rey, M
Journal:
Lancet
Abstract:
In most developing countries, bacterial meningitis (BM) is associated with a high case-fatality rate. The search for a simple, convenient, and inexpensive antibiotic treatment remains a priority. In this study, a non-blinded, multicentre, randomised clinical trial of 528 cases of BM was done in two hospitals in Mali and Niger, between March, 1989, and May, 1990, to see whether a double injection of long-acting chloramphenicol (on admission to hospital and 48 h later) is as effective as a course of intravenous ampicillin (8 days, 4 times a day). The cumulative case-fatality rate on day 4 (principal end-point) among the chloramphenicol (254 patients) and ampicillin (274) groups were, respectively, 28% and 24.5% (relative risk 1.14, 95% confidence interval 0.86-1.52). No outbreak occurred during the study period. The hospital case-fatality rate was 33.1%. Main risk factors for death were associated with clinical condition on admission--ie, altered consciousness, convulsions, or dehydration. The case-fatality rates were 13% (21/161) for Neisseria meningitidis, 36.1% (48/133) for Haemophilus influenzae, and 67% (77/115) for Streptococcus pneumoniae. In a multiple logistic regression model, controlling for the differential distribution of potential risk factors (including bacterial species), there was no difference between treatment groups. Our findings suggest that long-acting chloramphenicol is a useful first-line presumptive treatment for BM in high-incidence countries.
Affiliation:
Epicentre, Paris, France.
Publisher:
Elsevier
Issue Date:
5-Oct-1991
URI:
http://hdl.handle.net/10144/19393
PubMed ID:
1681224
Additional Links:
http://www.thelancet.com
Language:
en
ISSN:
0140-6736
Appears in Collections:
Other Diseases

Full metadata record

DC FieldValue Language
dc.contributor.authorPécoul, B-
dc.contributor.authorVaraine, F-
dc.contributor.authorKeita, M-
dc.contributor.authorSoga, G-
dc.contributor.authorDjibo, A-
dc.contributor.authorSoula, G-
dc.contributor.authorAbdou, A-
dc.contributor.authorEtienne, J-
dc.contributor.authorRey, M-
dc.date.accessioned2008-02-29T08:49:07Z-
dc.date.available2008-02-29T08:49:07Z-
dc.date.issued1991-10-05-
dc.identifier.citationLong-acting chloramphenicol versus intravenous ampicillin for treatment of bacterial meningitis. 1991, 338 (8771):862-6 Lanceten
dc.identifier.issn0140-6736-
dc.identifier.pmid1681224-
dc.identifier.urihttp://hdl.handle.net/10144/19393-
dc.description.abstractIn most developing countries, bacterial meningitis (BM) is associated with a high case-fatality rate. The search for a simple, convenient, and inexpensive antibiotic treatment remains a priority. In this study, a non-blinded, multicentre, randomised clinical trial of 528 cases of BM was done in two hospitals in Mali and Niger, between March, 1989, and May, 1990, to see whether a double injection of long-acting chloramphenicol (on admission to hospital and 48 h later) is as effective as a course of intravenous ampicillin (8 days, 4 times a day). The cumulative case-fatality rate on day 4 (principal end-point) among the chloramphenicol (254 patients) and ampicillin (274) groups were, respectively, 28% and 24.5% (relative risk 1.14, 95% confidence interval 0.86-1.52). No outbreak occurred during the study period. The hospital case-fatality rate was 33.1%. Main risk factors for death were associated with clinical condition on admission--ie, altered consciousness, convulsions, or dehydration. The case-fatality rates were 13% (21/161) for Neisseria meningitidis, 36.1% (48/133) for Haemophilus influenzae, and 67% (77/115) for Streptococcus pneumoniae. In a multiple logistic regression model, controlling for the differential distribution of potential risk factors (including bacterial species), there was no difference between treatment groups. Our findings suggest that long-acting chloramphenicol is a useful first-line presumptive treatment for BM in high-incidence countries.en
dc.language.isoenen
dc.publisherElsevier-
dc.relation.urlhttp://www.thelancet.com-
dc.rightsReproduced on this site with permission of Elsevier Ltd. Please see www.thelancet.com for further relevant comment.en
dc.subject.meshAmpicillinen
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshChloramphenicolen
dc.subject.meshDrug Resistance, Microbialen
dc.subject.meshHaemophilus Infectionsen
dc.subject.meshHaemophilus influenzaeen
dc.subject.meshHumansen
dc.subject.meshInfanten
dc.subject.meshInjections, Intramuscularen
dc.subject.meshInjections, Intravenousen
dc.subject.meshKlebsiella pneumoniaeen
dc.subject.meshMeningitis, Bacterialen
dc.subject.meshMeningitis, Meningococcalen
dc.subject.meshMeningitis, Pneumococcalen
dc.subject.meshNeisseria meningitidisen
dc.subject.meshNervous System Diseasesen
dc.subject.meshProteus mirabilisen
dc.subject.meshStreptococcus pneumoniaeen
dc.subject.meshSurvival Rateen
dc.titleLong-acting chloramphenicol versus intravenous ampicillin for treatment of bacterial meningitis.en
dc.contributor.departmentEpicentre, Paris, France.en
dc.identifier.journalLanceten

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