The report of gram-negative bacillary meningitis successfully treated by intravenous (IV) trimethoprim-sulfamethoxazole presented in this issue of The Journal by Hickstein and Dillon (p 1212) illustrates the difficulty encountered in therapy for this infection and the need to monitor efficacy by following CSF bactericidal levels of the antibiotic employed. The authors present an example of meningitis after a neurosurgical procedure caused by a gram-negative aerobic bacillus refractory to antibiotic therapy. Although gram-negative bacillary meningitis represents only a portion of the total cases of bacterial meningitis, it has long been associated with a significant mortality (40% to 70%) and excessive morbidity.1 Spurred by recent experience with the newer β-lactam antibiotics (moxalactam disodium and cefotaxime sodium) and the availability of an IV preparation of trimethoprim-sulfamethoxazole, more reports of the successful therapy for gram-negative meningitis are appearing in the literature.2
In the present report, chloramphenicol, an antibiotic traditionally used to treat
Gates RH, McCall CE. Gram-negative Bacillary Meningitis. JAMA. 1982;248(10):1217–1218. doi:10.1001/jama.1982.03330100055033
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