Delayed Sterilization of Haemophilus influenzae Type b Meningitis With Twice-Daily Ceftriaxone

Abstract

THE CURRENT recommendation for the treatment of bacterial meningitis in children older than 3 months of age is the combination of ampicillin sodium and chloramphenicol sodium succinate.^1,2Concern about the toxicity of chloramphenicol and the potential resistance of bacteria to both drugs has prompted investigation of other agents. In both of the official American Academy of Pediatrics publications, specific second- and third-generation cephalosporins are recommended as possible alternatives to initial therapy.^1,2The relatively low toxicity, the excellent penetration of these drugs into cerebrospinal fluid (CSF), and the marked sensitivity (minimal inhibitory concentration [MIC] and bactericidal titers) of pediatric isolates that cause meningitis have made these single-drug regimens attractive to clinicians.^3-6Recent clinical studies have demonstrated the efficacy of ceftriaxone in treating bacterial meningitis in children.^7-10We describe an infant with<i>Haemophilus influenzae</i>, type b bacteremia and pneumonia who had a positive CSF culture for<i>H influenzae</i>