title: Initial treatment of bacterial meningitis in Yaounde, Cameroon: theoretical benefits of the ampicillin-chloramphenicol combination versus chloramphenicol alone.
abstract: A prospective 6-month study in Yaounde evaluated 49 children aged from 2 months to 8 years, hospitalized with bacterial meningitis. They were randomly assigned to one of two initial treatment groups, either an ampicillin-chloramphenicol combination (group A) or chloramphenicol alone (group B). The majority of patients were infected with Haemophilus influenzae, and the majority of deaths were caused by Streptococcus pneumoniae. Altogether, 17.9% of Haemophilus influenzae isolates were ampicillin-resistant and 3.6% chloramphenicol-resistant. We found no isolate resistant to both antibiotics. Response to both treatments was similar in both groups. The theoretical risk of treatment failure with ampicillin was higher than with the ampicillin-chloramphenicol combination (p less than 0.05). There was no statistically significant difference between the risk of treatment failure with the ampicillin-chloramphenicol combination and the risk with chloramphenicol alone (p less than 0.05), but the latter was increased by the occurrence of chloramphenicol-resistant isolates of Streptococcus pneumoniae (11.1%). Although treatment with an ampicillin-chloramphenicol combination is four times more expensive than treatment with chloramphenicol alone, costwise it is also one-quarter the price of a third-generation cephalosporin (moxalactam). At present, the ampicillin-chloramphenicol combination can be suggested as the first choice for initial treatment considering both the epidemiological data and the cost/efficiency ratio in the area of Yaounde.
authors.affiliation: Hôpital Central de Yaounde, CUSS, Cameroon.
authors.forename: E
authors.initials: E
authors.lastname: Tetanye
authors.forename: D
authors.initials: D
authors.lastname: Yondo
authors.forename: A C
authors.initials: AC
authors.lastname: Bernard-Bonnin
authors.forename: P F
authors.initials: PF
authors.lastname: Tchokoteu
authors.forename: I
authors.initials: I
authors.lastname: Kago
authors.forename: M
authors.initials: M
authors.lastname: Ndayo
authors.forename: J
authors.initials: J
authors.lastname: Mbede
mesh_terms: D000667:Ampicillin / Q000008:administration & dosage / Q000627:therapeutic use*; D000668:Ampicillin Resistance; D001424:Bacterial Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D002163:Cameroon / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002701:Chloramphenicol / Q000008:administration & dosage / Q000627:therapeutic use*; D002702:Chloramphenicol Resistance; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D006801:Humans; D007223:Infant; D008581:Meningitis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D002701:Chloramphenicol; D000667:Ampicillin