Improving the outcome of bacterial meningitis in newborn infants in Malawi

Current research

Bacterial meningitis is 10 times more common in developing countries than in the West. Many children die or are left with neurological problems. Meningitis is particularly common in infants under 2 months of age and the death rate is about 50%. There are several reasons for this; one is that the standard antibiotics used are no longer as effective as they used to be. Bacterial resistance to the standard antibiotics has increased and, worryingly, some infections may only be partly treated and not eradicated by present therapy.

The standard treatments (the antibiotics Penicillin and Gentamicin) are cheap and available, but require 4 injections a day, for at least 14 days - a total of 58 injections. Many mothers are upset by the number of injections and discharge their children from hospital before treatment can be completed. Our standard second choice of antibiotic is ceftriaxone, which is also available and cheap and has the advantage of being given as a daily injection. The disadvantages are that it can cause (reversible) jaundice particularly in premature babies and that it must not be given with calcium products.

All the most common causes of bacterial meningitis in this age group are treatable by ceftriaxone.

In this study we will compare penicillin and gentamicin versus ceftriaxone as a standard treatment for infant meningitis. We think that the ceftriaxone trial group will have 20% fewer deaths than the penicillin and gentamicin group. If ceftriaxone is shown to be a better standard therapy, then this project could bring about a change in clinical practice that could save many lives in Malawi and other African countries affected by meningitis outbreaks.