Skip to main content
NCBI home page
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
. 1995 May;39(5):1140–1146. doi: 10.1128/aac.39.5.1140

Randomized comparison of meropenem with cefotaxime for treatment of bacterial meningitis. Meropenem Meningitis Study Group.

K P Klugman 1, R Dagan 1
PMCID: PMC162697  PMID: 7625802

Abstract

Broad-spectrum cephalosporins are drugs of choice for the treatment of meningitis in communities which can afford them. The emergence of cephalosporin-resistant pneumococci demands the clinical trial of alternate agents. Carbapenems are active against the bacteria causing meningitis, but the use of imipenem-cilastatin was frustrated by drug-associated seizures. The safety and efficacy of meropenem, a new carbapenem, were compared to those of cefotaxime in a prospective randomized trial of 190 children with bacterial meningitis. Seizures occurred within 24 h before antibiotic therapy in 16 of 98 patients (16%) randomized to receive meropenem and in 6 of 92 patients (7%) randomized to receive cefotaxime. In patients without seizures before therapy, seizures occurred during therapy in 5 of 82 patients (6%) receiving meropenem and in 1 of 86 patients (1%) receiving cefotaxime (95% confidence interval: -0.7%, 10.6%). None were thought to be drug related. Twenty-four meropenem-treated patients (24%) and 11 cefotaxime-treated patients (12%) had neurological abnormalities before therapy. In patients without pretherapy neurological abnormalities, these abnormalities were present after treatment in 4 of 74 meropenem-treated patients (5%) and in 2 of 81 cefotaxime-treated patients (2%) (95% confidence interval: -3.2%, 9.1%). Of 75 meropenem-treated and 64 cefotaxime-treated patients with pretherapy positive cerebrospinal-fluid cultures, 68 and 59, respectively, had repeat lumbar punctures. Bacterial eradication was found to be 100% in both groups. Our data suggest that meropenem may be a carbapenem agent that is well tolerated and effective in the treatment of bacterial meningitis.

Full Text

The Full Text of this article is available as a PDF (196.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Asensi F., Otero M. C., Pérez-Tamarit D., Rodríguez-Escribano I., Cabedo J. L., Gresa S., Cantón E. Risk/benefit in the treatment of children with imipenem-cilastatin for meningitis caused by penicillin-resistant pneumococcus. J Chemother. 1993 Apr;5(2):133–134. doi: 10.1080/1120009x.1993.11739221. [DOI] [PubMed] [Google Scholar]
  2. Asensi F., Pérez-Tamarit D., Otero M. C., Gallego M., Llanes S., Abadia C., Cantó E. Imipenem-cilastatin therapy in a child with meningitis caused by a multiply resistant pneumococcus. Pediatr Infect Dis J. 1989 Dec;8(12):895–895. doi: 10.1097/00006454-198912000-00019. [DOI] [PubMed] [Google Scholar]
  3. Bradley J. S., Connor J. D. Ceftriaxone failure in meningitis caused by Streptococcus pneumoniae with reduced susceptibility to beta-lactam antibiotics. Pediatr Infect Dis J. 1991 Nov;10(11):871–873. [PubMed] [Google Scholar]
  4. Catchpole C. R., Wise R., Thornber D., Andrews J. M. In vitro activity of L-627, a new carbapenem. Antimicrob Agents Chemother. 1992 Sep;36(9):1928–1934. doi: 10.1128/aac.36.9.1928. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Chmelik V., Gutvirth J. Meropenem treatment of post-traumatic meningitis due to Pseudomonas aeruginosa. J Antimicrob Chemother. 1993 Dec;32(6):922–923. doi: 10.1093/jac/32.6.922. [DOI] [PubMed] [Google Scholar]
  6. Dagan R., Velghe L., Rodda J. L., Klugman K. P. Penetration of meropenem into the cerebrospinal fluid of patients with inflamed meninges. J Antimicrob Chemother. 1994 Jul;34(1):175–179. doi: 10.1093/jac/34.1.175. [DOI] [PubMed] [Google Scholar]
  7. Davey P. G., Cruikshank J. K., McManus I. C., Mahood B., Snow M. H., Geddes A. M. Bacterial meningitis--ten years experience. J Hyg (Lond) 1982 Jun;88(3):383–401. doi: 10.1017/s002217240007025x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Donnelly J. P., Horrevorts A. M., Sauerwein R. W., De Pauw B. E. High-dose meropenem in meningitis due to Pseudomonas aeruginosa. Lancet. 1992 May 2;339(8801):1117–1117. doi: 10.1016/0140-6736(92)90714-e. [DOI] [PubMed] [Google Scholar]
  9. Friedland I. R., Klugman K. P. Failure of chloramphenicol therapy in penicillin-resistant pneumococcal meningitis. Lancet. 1992 Feb 15;339(8790):405–408. doi: 10.1016/0140-6736(92)90087-j. [DOI] [PubMed] [Google Scholar]
  10. Fujii R., Yoshioka H., Fujita K., Maruyama S., Sakata H., Inyaku F., Chiba S., Tsutsumi H., Wagatsuma Y., Fukushima N. [Pharmacokinetic and clinical studies with meropenem in the pediatric field. Pediatric Study Group of Meropenem]. Jpn J Antibiot. 1992 Jun;45(6):697–717. [PubMed] [Google Scholar]
  11. Herson V. C., Todd J. K. Prediction of morbidity in Hemophilus influenzae meningitis. Pediatrics. 1977 Jan;59(1):35–39. [PubMed] [Google Scholar]
  12. James H. E. Neurologic evaluation and support in the child with an acute brain insult. Pediatr Ann. 1986 Jan;15(1):16–22. doi: 10.3928/0090-4481-19860101-05. [DOI] [PubMed] [Google Scholar]
  13. Jennett B., Teasdale G., Braakman R., Minderhoud J., Knill-Jones R. Predicting outcome in individual patients after severe head injury. Lancet. 1976 May 15;1(7968):1031–1034. doi: 10.1016/s0140-6736(76)92215-7. [DOI] [PubMed] [Google Scholar]
  14. Jones R. N., Barry A. L., Thornsberry C. In-vitro studies of meropenem. J Antimicrob Chemother. 1989 Sep;24 (Suppl A):9–29. doi: 10.1093/jac/24.suppl_a.9. [DOI] [PubMed] [Google Scholar]
  15. Jorgensen J. H., Maher L. A., Howell A. W. Activity of meropenem against antibiotic-resistant or infrequently encountered gram-negative bacilli. Antimicrob Agents Chemother. 1991 Nov;35(11):2410–2414. doi: 10.1128/aac.35.11.2410. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. McCracken G. H., Jr, Nelson J. D., Kaplan S. L., Overturf G. D., Rodriguez W. J., Steele R. W. Consensus report: antimicrobial therapy for bacterial meningitis in infants and children. Pediatr Infect Dis J. 1987 Jun;6(6):501–505. [PubMed] [Google Scholar]
  17. Muñoz R., Dowson C. G., Daniels M., Coffey T. J., Martin C., Hakenbeck R., Spratt B. G. Genetics of resistance to third-generation cephalosporins in clinical isolates of Streptococcus pneumoniae. Mol Microbiol. 1992 Sep;6(17):2461–2465. doi: 10.1111/j.1365-2958.1992.tb01422.x. [DOI] [PubMed] [Google Scholar]
  18. Nilsson-Ehle I., Hutchison M., Haworth S. J., Norrby S. R. Pharmacokinetics of meropenem compared to imipenem-cilastatin in young, healthy males. Eur J Clin Microbiol Infect Dis. 1991 Feb;10(2):85–88. doi: 10.1007/BF01964413. [DOI] [PubMed] [Google Scholar]
  19. Nouda H., Harabe E. T., Sumita Y., Okuda T., Fukasawa M. Beta-lactamase stability and inhibitory activity of meropenem combined with a potent antibacterial activity. Chemotherapy. 1992;38(4):218–224. doi: 10.1159/000239004. [DOI] [PubMed] [Google Scholar]
  20. Patel J. B., Giles R. E. Meropenem: evidence of lack of proconvulsive tendency in mice. J Antimicrob Chemother. 1989 Sep;24 (Suppl A):307–309. doi: 10.1093/jac/24.suppl_a.307. [DOI] [PubMed] [Google Scholar]
  21. Spangler S. K., Jacobs M. R., Appelbaum P. C. Susceptibilities of 177 penicillin-susceptible and -resistant pneumococci to FK 037, cefpirome, cefepime, ceftriaxone, cefotaxime, ceftazidime, imipenem, biapenem, meropenem, and vancomycin. Antimicrob Agents Chemother. 1994 Apr;38(4):898–900. doi: 10.1128/aac.38.4.898. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Tan T. Q., Schutze G. E., Mason E. O., Jr, Kaplan S. L. Antibiotic therapy and acute outcome of meningitis due to Streptococcus pneumoniae considered intermediately susceptible to broad-spectrum cephalosporins. Antimicrob Agents Chemother. 1994 May;38(5):918–923. doi: 10.1128/aac.38.5.918. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Williams P. D., Bennett D. B., Comereski C. R. Animal model for evaluating the convulsive liability of beta-lactam antibiotics. Antimicrob Agents Chemother. 1988 May;32(5):758–760. doi: 10.1128/aac.32.5.758. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Wong V. K., Wright H. T., Jr, Ross L. A., Mason W. H., Inderlied C. B., Kim K. S. Imipenem/cilastatin treatment of bacterial meningitis in children. Pediatr Infect Dis J. 1991 Feb;10(2):122–125. doi: 10.1097/00006454-199102000-00009. [DOI] [PubMed] [Google Scholar]

Articles from Antimicrobial Agents and Chemotherapy are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES