title: Glycerol and acetaminophen as adjuvant therapy did not affect the outcome of bacterial meningitis in Malawian children.
abstract: We investigated the benefit of 2 candidate adjunctive therapies in bacterial meningitis: glycerol, which has shown promise in earlier studies, and acetaminophen, which is reportedly beneficial in adult septicemia. In a hospital in Blantyre, Malawi, we enrolled 360 children aged ≥ 2 months with proven bacterial meningitis (36% HIV infected) in a double-blind, randomized, placebo-controlled trial of glycerol and acetaminophen in a 2 × 2 factorial design. Of 4 groups, first group received oral glycerol, second received rectal acetaminophen, third received both therapies and the fourth received placebos only. Adjuvant therapies were given for the first 48 hours of antibiotic therapy. Endpoints were mortality and neurological sequelae. Baseline findings were similar across all groups, except that many children had prior antibiotics in the acetaminophen group and many were anemic in the acetaminophen and glycerol group. Outcomes were similar for all groups. We found no benefit from oral glycerol or rectal acetaminophen in, mostly pneumococcal, meningitis in Malawian children.
authors.affiliation: From the *Department of Pediatrics and Child Health, College of Medicine, Malawi; †Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK; ‡National Institute for Health and Welfare; and §Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Molyneux
authors.forename: Kondwani
authors.initials: K
authors.lastname: Kawaza
authors.forename: Ajib
authors.initials: A
authors.lastname: Phiri
authors.forename: Yamikani
authors.initials: Y
authors.lastname: Chimalizeni
authors.forename: Limangeni
authors.initials: L
authors.lastname: Mankhambo
authors.forename: Edward
authors.initials: E
authors.lastname: Schwalbe
authors.forename: Matti
authors.initials: M
authors.lastname: Kataja
authors.forename: Paul
authors.initials: P
authors.lastname: Pensulo
authors.forename: Lucy
authors.initials: L
authors.lastname: Chilton
authors.forename: Heikki
authors.initials: H
authors.lastname: Peltola
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005990:Glycerol / Q000627:therapeutic use*; D034381:Hearing Loss / Q000382:microbiology; D006801:Humans; D007223:Infant; D008295:Malawi; D016920:Meningitis, Bacterial / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000082:Acetaminophen; D002443:Ceftriaxone; D005990:Glycerol