Meningitis: Ceftriaxone was an effective treatment

Clinical bottom line (level 4)

In the treatment of bacterial meningitis, ceftriaxone appeared as effective as ampicillin/chloramphenicol (NNT = 17 at unknown)

Girgis et al: Lancet 1989; 2: 510-

Expires January 2003

The study

Unblinded ?concealed ?randomised trial with intention-to-treat
Setting: Meningitis ward, Egypt

100 patients (aged 21.7 years (30 cases were 'adult, 15 cases 'paediatric'), ?% male) acute bacterial meningitis (by Gram stain of CSF)
Control Group: (n = 50, 50 analysed): ampicillin and chloramphenicol
Experimental Group: (n = 50, 50 analysed): ceftriaxone 100mg/kg (max 4g) OD for 6 days

100% followed for ? mortality

The evidence

Outcome	Time to outcome	CER	EER	RRR (95% CI)	ARR (95% CI)	NNT (95% CI)
mortality (all ages)	unknown	10 (20%)	7 (14%)	30% (-69% to 71%)	6.0% (-8.7% to 21%)	17 (NNT = 5 to infinity; NNH = 12 to infinity)
mortality (adults)	unknown	1 (6.7%)	1 (6.7%)	0% (-1350% to 93%)	0% (-17.9% to 17.9%)	- (NNT = 6 to infinity; NNH = 6 to infinity)

Comments

Details on population type and neurological sequelae are lacking.

Citation

Girgis NI, Farid Z, Bishay E: Ceftriaxone in Bacterial Meningitis. Lancet 1989; 2: 510-

Contributor: Bob Phillips and Clare Wotton, January 2000
Reviewer: Andreas Cerny

_{Clinical Question.}

_Patient	_meningitis
_{Intervention or Exposure}	_{ceftriaxone OD}
_Comparison	_{standard therapy; chloramphenicol & penicillin}
_Outcome	_mortality