Role of third-generation cephalosporins in the treatment of bacterial meningitis.

The third generation cephalosporins are very active against Haemophilus influenzae, including betalactamase producing strains, Neisseria meningitidis and against gram-negative bacilli. Considering that a CSF level at least 10 times the MIC for the causative agent must be achieved, some cephalosporins are limited in their use in meningitis. Randomized controlled studies are sparse and it is difficult to compare objectively the clinical efficacy of cephalosporins with that of commonly used regimens. Moxalactam, cefotaxime, ceftazidime and ceftriaxone were revealed as being at least as effective as standard antibiotics in the treatment of meningitis. Although the outcome from bacterial meningitis has not appreciably changed in a 14-year period from 1969 to 1982, when newer generation beta-lactam drugs were available, it is obvious that these drugs will be very useful in special situations, particularly where multiply resistant pathogens are involved. Finally, the role of third-generation cephalosporins in the treatment of bacterial meningitis is best approached by analysis based on age group and clinical setting.