17 infants and children with pyogenic
meningitis (14 Haemophilus influenzae, 2 Diplococcus pneumoniae, 1 Neisseria meningitidis) were treated with
thiamphenicol, 100 mg/kg
body weight/day in 4 doses i.v., as single
drug. In the H. influenzae group 10 patients were cured, 4 had relapses of
meningitis, 3 with documented subdural effusions. This group is compared with 14 children matched for age, initial leucocyte and CSF cell count treated with
ampicillin: all of these were cured, 1 had a
subdural effusion.
Thiamphenicol concentrations were determined in the serum and CSF 2 h after administration. The mean serum levels were between 10-12 mcg/ml, the mean CSF levels varied from 5.4 mcg/ml at the beginning to 1-1.9 mcg/ml at the end of
meningitis. The MIC of H. influenzae was 0.6-12 mcg/ml. A significant, acute, and dose related bone marrow toxicity of
thiamphenicol could be documented, but was always rapidly fully reversible. We conclude that
thiamphenicol cannot replace
chloramphenicol in the treatment of pyogenic
meningitis as single systemic
antibiotic. Special indications for
thiamphenicol in this disease are discussed.