Which medications in the drug class Antimicrobial agents are used in the treatment of Haemophilus Meningitis?

Updated: Jul 09, 2018
  • Author: Prateek Lohia, MD, MHA; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Antimicrobial agents

The most critical aspect of initial treatment for meningitis is prompt initiation of antimicrobial therapy, because any delay in treatment is associated with increased morbidity and mortality. Chloramphenicol was previously used to treat HiB meningitis but has fallen out of favor because of increasing resistance, potential myelotoxicity, lack of availability, and, most importantly, the availability of alternatives with a better safety profile.

Ampicillin

Ampicillin is a broad-spectrum penicillin. It interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. Ampicillin could be considered an option if HiB is known to be susceptible to the drug. Nontypable H influenzae strains, which are increasingly being encountered, tend to be susceptible to ampicillin.

Ceftriaxone (Rocephin)

Ceftriaxone is a third-generation cephalosporin with broad-spectrum, gram-negative activity and lower efficacy against gram-positive organisms. It also has higher efficacy against resistant organisms. Bactericidal activity results from inhibiting cell wall synthesis by binding to one or more penicillin-binding proteins. It exerts antimicrobial effect by interfering with the synthesis of peptidoglycan, a major structural component of the bacterial cell wall. Bacteria eventually lyse due to the ongoing activity of cell wall autolytic enzymes, while cell wall assembly is arrested. It is highly stable in the presence of beta-lactamases, both penicillinase and cephalosporinase, of gram-negative and gram-positive bacteria.

Cefotaxime (Claforan)

Cefotaxime is a third-generation cephalosporin with a broad gram-negative spectrum, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms. It arrests bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins, which, in turn, inhibits bacterial growth. Its safety profile is more favorable than aminoglycosides. It is used to treat suspected or documented bacterial meningitis caused by susceptible organisms such as H influenzae or N meningitidis.

Meropenem (Merrem)

Meropenem is a carbapenem antibiotic and is considered an alternative to cephalosporins. It exerts its bactericidal activity by inhibiting cell wall synthesis and can be considered an option in patients who are intolerant of cephalosporins.


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