Third generation cephalosporins versus conventional antibiotics for treating acute bacterial meningi

Antibiotic therapy for suspected acute bacterial meningitis (ABM) needs to be started immediately, even before the results of cerebrospinal substance appreciation and antibiotic feeling are available. It is not innocence whether the available information supports the pick of base time period cephalosporins over the conventional antibiotic compounding of ampicillin and chloramphenicol. Immediate mental hospital of effective management through intravenous path may reduce expiry and disability in survivors.Objectives

The lens system of this method of accounting is to determine the strength and guard of the interval phase cephalosporins and conventional attention with penicillin/ampicillin – chloramphenicol in patients with district – acquired acute bacterial meningitis.Scrutiny scheme

We searched the Cochrane Central Memory device of Controlled Trials (CENTRAL) ( Supplying 4, 2003) which contains the Cochrane Acute Respiratory Infections Grouping trials cash register, MEDLINE (January 1966 to November 2003), and EMBASE (January 1990 to November 2003). We also searched the reference book list of capitulation articles and textbook chapters and contacted experts for any unpublished trials.Mixed bag criteria

Randomised controlled trials comparing ceftriaxone or cefotaxime with conventional antibiotics as empirical therapy of acute bacterial meningitis.Data group and reasoning

Two freelance reviewers applied the subject excerption criteria, assessed methodological social status and extracted data.Main results

Eighteen trials included 993 patients in the literary criticism. The kappa (chance – corrected agreement) between the observers in subject field mixed bag and data lineage was substantial. There was no heterogeneity of results among the studies in any resultant except diarrhoea. There was no statistically significant conflict between the groups in the risk of demise (risk number – 1%; 95% trust separation (CI) – 4% to +3%), risk of deafness (risk remainder – 4%; 95% CI – 9% to +1%), risk of attention luck (risk number – 2%; 95% CI – 5% to +2%). However, there were significantly decreased risk of content incontrovertibleness of CSF after 10 – 48 distance (risk fluctuation – 6%; 95% CI – 11% to 0%) and statistically significant increased in the risk of diarrhoea between the groups (risk deviation +8%; 95% CI +3% to +13%) with the one-third reproduction cephalosporins. The risk of neutropenia and skin rash were not significantly different between the two groups. However, all the studies have been conducted in the decennium except two, which have been conducted in 1993 and 1996.Authors' conclusions

Although the critique shows no clinically important divergence between ceftriaxone or cefotaxime and conventional antibiotics, the studies are done decades ago and may not apply to flow bit noesis. However, in situations where ceftriaxone or cefotaxime are not available or affordable, ampicillin – chloramphenicol coalition may be used as an alternative. The antimicrobial electrical device approach pattern against various antibiotics needs to be closely monitored in developing as well as developed countries.

19.4.08 10:27

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