Allen W. Mathies

Meningitis due to Listeria monocytogenes. A review of 25 cases.

Abstract Twenty-five patients with bacteriologically proved Listeria monocytogenes meningitis were studied. Twenty-one were male. Nine of the 25 were neonates, and 11 were 55 years of age or older. Twenty-four patients received either ampicillin or penicillin, at times in combination with other antibiotics. One of the ampicillin-treated patients, and six of the penicillin-treated patients died. Recovery of the patient from meningeal infection seemed to correlate best with an initial cerebrospinal-fluid glucose level over 30 mg per 100 ml. These data, like those already appearing in the literature, suggest that intravenous ampicillin may be the therapy of choice, from the standpoint of both superior efficacy and relative lack of toxicity.

H. INFLUENZAE MENINGITIS: A CONTROLLED STUDY OF TREATMENT WITH AMPICILLIN.

gitis, however, the drug was found in brain almost exclusively in animals with intensive signs of meningitis. Ampicillin, particularly in large doses, had a distinct therapeutic effect in experimental Hemophilus meningitis The pathological changes in the meninges corresponded to the clinical picture. In experiments with /3-streptococci and Haemophilus influenze, however, milld changes were discernible even before signs of meningitis had appeared.

Comparative Trial of Carbenicillin and Ampicillin Therapy for Purulent Meningitis

A randomized therapeutic trial of carbenicillin (CB) or ampicillin (AMP) in purulent meningitis was performed in 86 pediatric and adult patients (41 Haemophilus influenzae, 22 Streptococcus pneumoniae, 13 Neisseria meningitidis, and 10 of unknown etiology). All isolates, incuding H. influenzae, were susceptible to CB and AMP. Median cerebrospinal fluid (CSF) antibiotic concentrations were 0.85 and 1.60 μg/ml for CB and AMP, respectively, during administration of daily doses of 400 mg/kg and 0.65 and 0.45 μg/ml, respectively, on daily doses of 200 mg/kg. Higher CSF concentrations, up to a median concentration of 4.5 μg/ml, were observed in patients with CSF protein concentrations ≥75 mg/100 ml. Clinical responses were equivalent on either antibiotic regimen. Among AMP patients (45), 8 had significant residua and 3 died; among CB patients (41), 5 had residua and none died. However, 38% of H. influenzae patients treated with CB had positive CSF cultures on day 1 follow-up lumbar punctures, compared with only 5.8% of AMP patients with H. influenzae. The significance of a delay of CSF sterilization among CB-treated patients is unknown, since there was no correlation between persistence of hemophilus organisms and the frequency of adverse outcome. AMP and CB are equivalent for the treatment of bacterial meningitis due to susceptible organisms.

Susceptibility of hemophilus influenzae, type b, to ampicillin at Los Angeles County/University of Southern California Medical Center: A reappraisal after ten years*

SINCE 1963 AMPICILLIN has been used extensively for treatment of meningitis and other infections due to Hemophilus influenzae, type b. Prior reports from this institution 1 have documented marked susceptibility of these organisms to ampicillin. Recently strains of H. influenzae, type b, resistant to ampicillin have been recognized.2. 3 Thes e reports prompted a review of the in vitro susceptibility to ampicillin and chloramphenicol of recently isolated strains compared to those isolated in earlier years. Susceptibility studies performed against groups of organisms isolated during 1971-1972 and 1974 were compared with results of similar studies 1 of strains to H. influenzae, type b, isolated ten years earlier during 1962-1964.

Cranial bruits in purulent meningitis in childhood.

Abstract The frequency of cranial bruits in 55 patients with purulent meningitis as compared to that of 653 afebrile and 155 febrile patients without meningitis showed that 82 per cent of the patients with purulent meningitis between the ages of three months and five years had cranial bruits whereas bruits were heard in 22 per cent in the febrile control group and 16 per cent in the afebrile control group. The bruits associated with purulent meningitis are usually transitory, lasting one to four days after initiation of therapy. In three of the patients with purulent meningitis cranial bruits recurred in association with the development of subdural effusions. These bruits disappeared as the subdural effusions cleared. Cranial bruits may be another diagnostic point in the recognition of purulent meningitis, subdural effusions and other conditions associated with increased intracranial pressure.