Ceftriaxone in infant bacterial meningitis in Malawi
Dr MacPherson Mallewa, Dr Queen Dube, Prof Elizabeth Molyneux
- Start Date:
01 March 2010
Queen Elizabeth Central Hospital, Malawi-Liverpool-Wellcome Research Laboratories, College of Medicine, Blantyre, Malawi
The overall case fatality rate of meningitis in infants <2 months of age in Blantyre Malawi is 49%. Half the cases are caused by Gram-positive and half by Gram-negative bacteria. First line antimicrobial therapy is, according to WHO guidelines, parenteral penicillin and gentamicin. This covers some Gram-positive bacteria (namely Group B streptococci and some Strep pneumoniae
), but is not adequate for many Gram-negative infections, in particular non-typhoidal salmonellae that areis the second most common cause of meningitis in this age group. Gentamicin may ‘hold’ a NTS’ infection but it is unlikely to eradicate it from the CSF.
Second line antimicrobial therapy is ceftriaxone, which is the WHO recommendation as cefotaxime is not available. It has many advantages. Almost all bacteria cultures in our unit are sensitive to ceftriaxone. Generic ceftriaxone is affordable. It is available and importantly need only be given once daily. Mothers find the vast number of injections required for Pen and Gent (56- 70) abhorrent and may take their babies home without finishing treatment.Concerns have been raised about using ceftriaxone in premature infants especially if they are jaundiced or require calcium. We can monitor bilirubin levels and other electrolytes including calcium, provide phototherapy if necessary and have not given calcium to a neonate in the last 15 years.
This study will therefore look at the safety of ceftriaxone in infants under 2 months of age, by measuring levels of bilirubin. This will provide important data in the viability of ceftriaxone as a treatment option in this age group.