Long-acting chloramphenicol versus intravenous ampicillin for treatment of bacterial meningitis.
AffiliationEpicentre, Paris, France.
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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.
- Case-fatality ratio of bacterial meningitis in the African meningitis belt: we can do better.
- Authors: Boisier P, Maïnassara HB, Sidikou F, Djibo S, Kairo KK, Chanteau S
- Issue date: 2007 Sep 3
- Bacterial meningitis.
- Authors: Wehrle PF, Mathies AW, Leedom JM, Ivler D
- Issue date: 1967 Sep 27
- Bacterial profile and clinical outcome of childhood meningitis in rural Yemen: a 2-year hospital-based study.
- Authors: Al Khorasani A, Banajeh S
- Issue date: 2006 Oct
- Antimicrobial susceptibility of Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae isolates causing meningitis in The Netherlands, 1993-1994.
- Authors: Enting RH, Spanjaard L, van de Beek D, Hensen EF, de Gans J, Dankert J
- Issue date: 1996 Nov
- [Chemotherapy of purulent meningitis].
- Authors: Mortier W
- Issue date: 1970 May