We enrolled 95 pts. in an investigator blinded, randomized 1:1 trial of MER vs. CEF in PM. Fifty two (55%) had received antibiotics. Seventy (83%) had CSF isolates: 59 (75%) H. influenzae (H. Flu) type B, 11 (14%) S. pneumoniae (S. pneumo), PEN sensitive and 9(11%) N. meningitides (N.mening). Another pt's CSF was (+) for H. flu by (latex agglutination only). Twenty four (25%) had (+) blood cultures also. MER inhibited all H. flu at. 12 γ /ml, all N. mening at.011γ/ ml, all S. pneumo at 0.24 γ/ml. Pts. (3 mos to 12 yrs) got MER (40 mg/kg IV q 8 hrs) or CEF (45 mg/kg IV q 6 hrs). At admission 27 (28%) had seizures and 75 (79%) had Hgb. ≤ 10 gm/dl; they had been ill for a mean of 3.5 dys. (P=NS between groups). MER CSF level (1.4 γ/ml) 30 min after a dose was ≥ 12 × the MIC 100 for H. flu and N. mening and 6 × the MIC 100 for S. pneumo. There was one death (2%) in each group wi. 24 hrs. of Rx. There were no significant differences in outcome for MER vs CEF in BAER > 50:9(21%) vs 6(16%) P=NS, and severe psychometrics, 10(22%) vs 6(14%) P=NS at end of Rx; at 5-7 wk follow up BAER > 50, 8(28%) vs 6(19%) and psychometrics 5(16%) vs 4(13%), P=NS. Thus far 63 pts. have completed a 5-7 mo follow up, and both treatments were similarly effective. MER compared favorably to CEF in PM.

Supported in part by a grant from Zeneca.