Reply to "Initial Narrow- or Broad-spectrum Treatment for Meningoencephalitis".

The Authors Reply Thank you for reading our case report entitled, “Meningoencephalitis Caused by Campylobacter fetus in a Patient with Chronic Alcoholism”.

We understand your comment on our choice of ampicillin monotherapy. Empiric therapy should be started with broad-spectrum antibiotics. However, in this case, we chose ampicillin monotherapy for two reasons.

Initially, the clinical condition of the patient was not an emergency status. When we first contacted the patient, 6 days had already passed since his admission. Although he had a mild fever and presented with a mental disorder, his clinical status was nearly stable. After the administration of ampicillin, his symptoms and clinical status improved markedly. We carefully evaluated the daily physical examination data and laboratory data related to his mental disorder, which showed that his condition had improved. Hence, we continued ampicillin monotherapy.

The second reason for choosing ampicillin monotherapy was due to the duration of therapy. Previous studies have reported meningitis relapse after initial treatment with amoxicillin and ceftriaxone (1). However, in the two cases reported in the aforementioned study, the duration of therapy was only 2 weeks. After they changed the antibiotic to carbapenem, the therapy was continued for 3-4 weeks. Although there is no established treatment protocol for C. fetus meningoencephalitis, some investigators recommend prolonged treatment, and the duration of treatment might be important for achieving a complete cure. For these reasons, we selected 4 weeks of ampicillin monotherapy. If there had not been a good outcome after ampicillin monotherapy, we would have considered changing the antibiotic.

The authors state that they have no Conflict of Interest (COI).