Meropenem Monotherapy is a Valid Alternative in Community Acquired Adult Acute Bacterial Meningitis (ABM)

Abstract

Background: Meropenem (Merrem®, Meropenem®) is a broad-spectrum antibacterial carbapenem with indication for Acute Bacterial Meningitis (ABM). We wanted to specifically evaluate the effect of meropenem monotherapy, compared to standard recommended therapy. Method: A Swedish ongoing internet based quality register for ABM was started 1994 and covers the whole country with roughly 30 infectious disease clinics. After ethical approval data were extracted from the database and evaluated using conventional statistical methods (IBM SPSS Statistics 23). Results: The register contained 1708 patients altogether. All 770 patients (45%) given meropenem or cefotaxime/ampicillin were selected for this study. The age of the studied population was from 18-91 with a mean of 55 and median 60. Overall ABM mortality was 12.1% (197/1708). In the meropenem and cefotaxime/ampicillin subgroup 7.8% (60/770) died, p=0,035 and in the non-selected group 14,6 % (137/938), p<0.001. For meningococci the mortality was only 2% and for pneumococci 9% (p=0,025) and are record low figures in this selected population. The mortality increased 1.3 times (Odd’s ratio 1.3, p<0.001) with each decade of life and 1.5 times with each RLS stratification level (Odd’s ratio 1.5, p<0.001). Conclusion: There was no statistical significance in mortality (p=0.67) or sequelae rate between meropenem and cefotaxime/ampicillin treatment. Favourable outcome depends on speedy and correct antibiotic therapy as well as inclusion of betamethasone. Age, RLS and bacterial species, are factors, which cannot be influenced. Meropenem is a valid antibiotic choice in the Swedish population (with limited resistance problems).