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Chloramphenicol for Influenzal Meningitis

Gerard Marder, MD
JAMA. 1974;229(13):1722. doi:10.1001/jama.1974.03230510014008.
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To the Editor.—  In the article on Haemophilus influenzae resistance to ampicillin by Khan et al (229:298, 1974), I cannot understand why, after a careful study such as theirs, the authors still recommend ampicillin as the drug of first choice in treatment of H influenzae meningitis. Their recommendation to continue performing lumbar punctures daily for two or three days after admission and employing indices such as smears, cultures, blood cell count, enzyme studies, and clinical response to ampicillin, in addition to sensitivity test results by tube dilution methods, seems unreasonable and impossible for physicians out of ivory tower locations.Is ampicillin a "sacred cow"? Why should we agonize through days of therapy for a serious disease, to wonder whether the treatment will be effective or not? Haemophilus influenzae meningitis response to chloramphenicol has always been smoother and more prompt. The potential toxicity of chloramphenicol, for some reason, has never surfaced


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