Abstract
The role of third-generation cephalosporins in pediatric gram-negative CNS infections remains undefined. Therefore, we reviewed our experience with these drugs in 42 patients (ages 19 days to 11 years) with ventriculitis complicating hydrocephalus (14), or meningitis (28), 30 treated with moxalactam and 12 with ceftriaxone. Moxalactam dosages were 50-100 mg/kg q 8 hrs for 10-29 days, and ceftriaxone 50 mg/kg q 12 hrs for 10-31 days. Etiologic agents included H. influenzae type b (25), E. coli (8), klebsiella (6), E. cloacae (2), and salmonella (1). Median minimal inhibitory concentrations of moxalactam and ceftriaxone respectively for hemophilus were 0.055 and 0.003 μg/ml, and for enteric bacilli were 0.45 and 0.12 μg/ml. Levels in CSF or ventricular fluid ranged from 18-60 μg/ml for moxalactam and from 8.9-13.7 μg/ml for ceftriaxone. The bacteriologic cure rate was 100%. Clinical cures were demonstrated in 41/42 patients, with one patient unevaluable. No significant clinical side effects were noted; one patient had transient eosinophilia. The only complications were 2 patients with oral candidiasis and one with entero-coccal ventricular superinfection. No bleeding problems or significant diarrhea were encountered. Because of the safety and efficacy of moxalactam and ceftriaxone in the treatment of both gram-negative enteric and hemophilus CNS infections in children, these agents may now represent the drugs of choice for such infections.
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Chadwick, E., Shulman, S. & Yogev, R. DO THIRD-GENERATION CEPHALOSPORINS HAVE A ROLE IN GRAM-NEGATIVE CNS INFECTIONS?. Pediatr Res 18 (Suppl 4), 271 (1984). https://doi.org/10.1203/00006450-198404001-01066
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DOI: https://doi.org/10.1203/00006450-198404001-01066