Relapse of Gram-negative Bacillary Meningitis After Cefotaxime Therapy

Abstract

CONSIDERABLE enthusiasm has developed regarding the treatment of gram-negative bacillary meningitis with newly developed broad-spectrum, third-generation cephalosporin antibiotics. 1,2 Compared with other agents such as aminoglycosides or previously available cephalosporins, these antibiotics have remarkable activity against the organisms that cause this life-threatening infection. 3 The degree of penetration across the blood-brain barrier is so much greater for third-generation cephalosporins than the previously utilized antibiotics for gram-negative bacillary meningitis that many investigators now suggest that either cefotaxime sodium or moxalactam disodium is the drug of choice for this infection. 1 Since the proved therapy of intraventricular aminoglycoside administration may be associated with serious hazards, 4 the relative safety of cephalosporins is attractive. The relapse rate, however, has not been determined for this therapy with new cephalosporins. We recently gave one of these agents to a patient with gram-negative bacillary meningitis and observed an adequate initial response followed by relapse of infection.