Successful Treatment of Gram-Negative Bacillary Meningitis with Moxalactam

Abstract

Meningitis caused by enteric gram-negative bacilli is relatively uncommon but is very difficult to treat despite susceptibility in vitro to many antimicrobics. A major problem appears to be poor entry of many drugs into the CNS. Moxalactam is an investigational cephalosporin that attains concentrations in the CSF that are 15-30% of contemporaneous serum concentrations; it is quite active against many of the enteric gram-negative bacilli. Moxalactam was used to treat meningitis caused by Enterobacter cloacae, Klebsiella pneumoniae and Escherichia coli in 4 adults and 1 child, giving up to 100 mg/kg body weight per day by i.v. injection. The concentrations of moxalactam in serum, lumbar and ventricular CSF exceeded the minimal lethal concentrations of all causative bacteria. The patients were cured. In this small series, moxalactam, when administered i.v. as the sole agent of therapy, was effective in the treatment of meningitis caused by susceptible gram-negative bacilli.