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Acute obstructive hydrocephalus complicating bacterial meningitis

BMJ 1999; 318 doi: (Published 09 January 1999) Cite this as: BMJ 1999;318:123

In meningitis, one antibiotic is better than than two

  1. Christopher Settle, Specialist registrar.,
  2. Mark H Wilcox, Consultant
  1. Department of Microbiology, General Infirmary and University of Leeds, Leeds LS2 9JT
  2. New South Wales Newborn and Paediatric Transport Service, Westmead, Sydney 2145, Australia
  3. Royal Victoria Hospital, Belfast BT12 6BA
  4. Royal Liverpool Children's Hospital, Alder Hey, Liverpool L12 2AP

    EDITOR—A recent lesson of the week highlighted the possibility of meningitis in childhood presenting as obstructive hydrocephalus, with cerebrospinal fluid from ventriculostomy proving sterile but subsequent lumbar fluid yielding Streptococcus pneumoniae.1 In the two paediatric cases described, treatment consisted of both a third generation cephalosporin and benzylpenicillin. In children between 3months and 18years of age, however, it is recommended practice for empirical treatment to consist of a third generation cephalosporin alone. 23 The article may be misleading in giving the impression that use of two antibiotics in this type of case is routine.

    There is no sound microbiological basis for using a cephalosporin and a penicillin together, with the exception of patients who may be infected with Listeria monocytogenes. Listeriosis is extremely uncommon in England and Wales, with only 64reported cases in the first seven months of 1997,including a total of 14neonatal cases.4 A third generation cephalosporin is adequate cover for Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus pneumoniae, or Escherichia coli, and benzylpenicillin provides no extra benefit. Two βlactam antibiotics should not be given together unless this is unavoidable: there is potential for antagonistic interaction between agents, as both act by inhibiting cell wall synthesis. It …

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