Sulfonamides in Treatment of Meningococcal Meningitis

Abstract

To the Editor:— The article by Dr. Richard H. Meade on Treatment of Meningitis ( JAMA 185 :1023 [Sept 28] 1963) contains serious errors with respect to the concentrations of sulfonamides which reach the spinal fluid, and with regard to which drugs should be used in the treatment of meningococcal meningitis. Dr. Meade says that Sulfadiazine and sulfisoxazole reach the spinal fluid in concentrations that are 50% to 80% of those in the blood. No reference is given. These two drugs, as well as several others, have been compared in this respect by W. P. Boger in Antibiotic Medicine and Clinical Therapy ( 6 :32, 1959). His figures are as follows: for sulfadiazine the cerebrospinal fluid (CSF) concentration is 10% that of plasma; for sulfisoxazole the CSF concentration is 1.6% that of plasma. There are numerous other studies which also show that the diffusion of sulfisoxazole from plasma to CSF is slow.