Treatment of meningitis and septicemia in infancy with a sulphamethoxazole/trimethorpim combination

Abstract

Ten infants, 8 days to 10 months old, with meningitis and/or septicemia were considered therapeutic failures after conventional antibiotic treatment (i.e. kanamycin, ampicillin and sulfonamides) and given sulphamethoxazole and trimethoprim parenterally. Nine patients recovered, 8 of them rapidly, and one after prolonged treatment for 34 days when kanamycin was added to the combination. One infant improved but later died of complications not related to the treatment. High concentrations in serum and cerebrospinal fluid were achieved with a daily dose of 30-40 mg sulphamethoxazole and 6-8 mg trimethoprim per kg without signs of accumulation. No change in resistance of the bacteria isolated was seen. A hemolytic reaction, probably due to the propylene glycol in the solution, was seen in one case. Other possible side-effects in this age-group are discussed. The antibiotic combination used seems to be a good alternative in the therapy of bacterial meningitis of infants caused by gram-negative bacteria. However it should still not be given to icteric or very immature infants and probably not during the first week of life.