Sulbactam/ampicillin in the treatment of epidemic meningococcal meningitis in northern Nigeria.

Abstract

Epidemics of meningitis due to Neisseria meningitidis have occurred in the Guinea Savannah region of Africa every 5 to 10 years over the past 100 years (Lapeysonnie 1963), with smaller outbreaks occurring in the intervening years (Greenwood et al. 1979). For several decades, sulphonamide drugs were the mainstay of therapy. However, strains of N meningitidis resistant to sulphonamides have emerged recently and spread to many regions in the 'meningitis belt' (Lefevre et al. 1969; Sanborn 1969). During the 1977 meningococcal meningitis outbreak in Zaria, the minimum inhibitory concentration (MIC) of sulphadiazine against 52 strains of N meningitidis type A increased from 10 to 50 mg/L or greater (Hassan-King et al. 1979). Treatment of meningococcal meningitis has therefore shifted to penicillins and chloramphenicol, to which the causative organisms are still sensitive (Sangster et al. 1982; Whittle et al. 1 973a). These drugs are administered at 6-hourly intervals in the initial phase of the illness. Long acting penicillins are also effective and have the advantage of less frequent administration (Macfarlane et al. 1979; Sangster et al. 1982). Chloramphenicol, however, requires close patient monitoring. Penicillins are not effective against organisms that produce penicillinase enzymes. Therefore, new antibiotic preparations have to be evaluated to determine their efficacy in meningococcal meningitis. Sulbactam/ampicillin is a preparation in which the sulbactam component protects the ampicillin against the effects of ~-Iac­ tamase. Sulbactam, a derivative of the penicillin nucleus, diffuses readily into most body tissues and fluid. However, penetration into the brain and cerebrospinal fluid is low, except when the meninges are inflamed, as in acute meningococcal meningitis. During the 1986 meningitis epidemic in Zaria, an evaluation of sulbactam/ampicillin in the treatment of meningococcal meningitis was undertaken.