Evaluation of Cefamandole Therapy of Patients with Bacterial Meningitis

The efficacy of cefamandole in treatment of bacterial meningitis was evaluated. The penetration of the drug into the cerebrospinal fluid (CSF) was determined in 20 patients with meningitis due to Neisseria meningitidis or Streptococcus pneumoniae treated concurrently with penicillin. Concentrations of cefamandole in CSF reflected serum concentrations of the drug. The concentration in CSF (mean ± standard error) was 3.35 ± 1.47 μg/ml when the simultaneous serum concentration was > 20 μg/ml; 1.01 ± 0.46 μg/ml when the serum level was 10–20 μg/ml; 0.94 ± 0.47 p,g/ml when the serum level was 5–10 μg/ml; and 0.34 ± 0.12 μg/ml when the serum level was <5 μg/ml. Concentrations of cefamandole in CSF varied directly with concentration of protein in CSF. In the second part of the study, 26 additional patients with purulent meningitis were treated with cefamandole alone in a dose of 175–200 mg/kg per day. One of 16 patients with meningococcal meningitis died within 6 hr of hospitalization, and one of six patients with no organism isolated died within 36 hr of admission to the hospital. All other patients including one with pneumococcal meningitis and three with meningitis due to Haemophilus influenzae responded rapidly to treatment with cefamandole. Adverse effects were limited to phlebitis, one episode of urticaria, and transient elevations in levels of liver enzymes.