Experience with the use of
first-generation cephalosporins in
bacterial meningitis has been disappointing; low concentrations were obtained in the cerebrospinal fluid, and therapeutic failures were encountered. Of the
second-generation cephalosporins cefamandole,
cefuroxime, and
cefoxitin, only
cefuroxime has proved efficacy in
meningitis caused by meningococci, pneumococci, or Hemophilus influenzae. The
third-generation cephalosporins offer new advantages in the treatment of
meningitis because they are active at the cerebrospinal fluid concentrations obtainable.
Cefotaxime has produced high cure rates in patients with
meningitis caused by meningococci, pneumococci, or H. influenzae. Several controlled comparative studies indicate that
ceftriaxone is as effective as conventional treatment in
therapy for neonatal or childhood
meningitis caused by Streptococcus agalactiae, Escherichia coli, or H. influenzae.
Moxalactam has been found in uncontrolled studies to be effective when the cause was enteric gram-negative bacilli.
Ceftazidime is a new
cephalosporin with a high degree of
beta-lactamase stability and a broad antibacterial spectrum, which includes Pseudomonas aeruginosa that enters the cerebrospinal fluid. Data from 29 patients who received
ceftazidime as monotherapy for
bacterial meningitis showed an overall cure or improvement rate of 75.9 percent.
Therapy failed in three patients with
meningitis caused by gram-positive organisms (Staphylococcus aureus, S. epidermidis, S. agalactiae), and in three with gram-negative organisms. Of 14 patients with Pseudomonas
meningitis, 11 showed a cure, as did six of six patients with
meningitis caused by Enterobacter, Serratia, or Acinetobacter. More, preferably controlled, studies of the efficacy of
ceftazidime in the treatment of
meningitis should be undertaken.