Ceftriaxone in Haemophilus influenzae Type b Meningitis-Reply

Richard F. Jacobs, MD
JAMA. 1988;259(19):2852. doi:10.1001/jama.1988.03720190023024.
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In Reply.  —I am in agreement with Dr Bradley regarding his statement that our case does not warrant a change in recommendations for cephalosporin therapy as an equally effective alternative to ampicillin and chloramphenicol in children with meningitis. This continued enthusiasm for cephalosporins is reflected in the empirical antibiotic regimens utilized in infants and children with suspected meningitis at Arkansas Children's Hospital. Older infants (out of the nursery and up to 3 months of age) receive ampicillin and cefotaxime; children over 3 months of age receive cefotaxime alone pending culture and susceptibility data.I disagree that the most likely explanation in this case is an antibiotic dosing or laboratory error. The physician orders, nurse medication log, and pharmacy log corroborated a regimen of 50 mg/kg of ceftriaxone every 12 hours. It would be difficult to explain the growth of H influenzae type b from a CSF sample that was consistent


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