Letters to the Editor
II9
of treatment of shigellosis in adults and lends support to the observation made by Gotuzzo et al., 5 who found that single-dose treatment with norfloxacin for acute shigeUosis in adults is as effective as standard 5-day treatment with co-trimoxazole. Moreover, single-dose treatment has the advantage of being less expensive and promotes better patient compliance.
National Institute of Cholera and Enteric Diseases, P-33, C I T Road, Scheme X M , Beliaghata, Calcutta 7oooio, India and Infectious Diseases Hospital, Beliaghata, Calcutta 7oooio, India
I. 2. 3. 4. 5.
S. K. Bhattacharya M. K. Bhattacharya D. Dutta P. Durra M. Paul D. Sen S. Sarkar A. Saha (Chowdhury) S. C. Pal
References Pal SC. Epidemic bacillary dysentery in West Bengal, India, I984. Lancet I984; i: I462. Sen D, Dutta P, Deb BC, Pal SC. Nalidixic acid-resistant Shigella dysenteriae type I in eastern India. Lancet I988 ; ii: 9I I. Rogerio F, Ott D, Vandepitle J, Verbist L, Lemmens P, Habiyaremye I. Comparison of norftoxacin and nalidixic acid for treatment of dysentery caused by Shigella dysenteriae type I in adults. Antimicrob Agents Chemother I986; z9: 883-886. Bennish ML, Salam MA, Haider R, Barza M. Therapy for shigellosis. II. Randomized, double-blind comparison of ciprofloxacin and ampicillin. J Infect Dis I99o; 162:71 I - 7 I6. Gotuzzo E, Oberhelman RA, Maguina C et al. Comparison of single-dose treatment with norfloxacin and standard 5-day treatment with Trimethoprim-Sulfamethoxazole for acute shigellosis in adults. Antimicrob Agents Chemother I989; 33: I I o I - I I o 4 .
A n t i m i c r o b i a l c h e m o t h e r a p y o f m e n i n g i t i s due to Listeria monocytogenes in a d u l t s Accepted for publication I3 January I992 Sir, In a recent case report Mascola et al. 1 speculate on the use of second- and thirdgeneration cephalosporins in the treatment of listeria meningitis after describing infection of a black child in the U.S.A. in which G r a m - n e g a t i v e and positive rods were seen in the CSF. W e are at present conducting a retrospective survey of the treatment of adult listeria meningitis in the U . K . and early analysis has shown that I4 of 8o patients received a cephalosporin, usually cefotaxime, either in combination or singly as initial therapy before listeria had been cultured. T h e mortality was 4 / I 4 (28.6%) in patients receiving a cephalosporin as part of all of their initial therapy, 2/7 (28.6%) in those receiving cephalosporin m o n o t h e r a p y , and I 9 / 6 6 (28.8%) in patients who received other antimicrobials as initial treatment. N o patients were treated for listeriosis with a cephalosporin once the microbiological diagnosis had been made, usually within 24 h of C S F being taken. T w e n t y - o n e of 80 (26"2%) patients had organisms seen on G r a m - s t a i n e d films of C S F , and G r a m - p o s i t i v e bacilli were reported to be present in I4. I n two patients the laboratory suggested the diagnosis of listeriosis. T h r e e C S F s were reported as having G r a m - p o s i t i v e cocci suggestive of pneumococci, and G r a m - n e g a t i v e rods or cocci were seen in the remainder. One of these patients was being treated penicillin which m a y result in listeria appearing to be
I2o
Letters to the Editor
Gram-negative. 2 O f those with a positive Gram-stained film 47"6% ( I o / 2 I ) received 'gold standard' therapy of ampicillin or penicillin with gentamicin compared with I8"6% ( r i / 5 9 ) who did not (P < o'oi). However, this had no effect on mortality. Interestingly I o / 2 I (47'6%) of those with organisms seen in the film died compared with I2/59 (20%) of those in whom no organisms were seen (P < 0"05), perhaps because they were more severely ill. In conclusion, our preliminary data suggest cephalosporins are not widely used in the U.K. as first-line treatment of suspected bacterial meningitis and that while some problems exist in interpretation of Gram-stained films and responding therapeutically to such results, more patients with listeriosis and bacteria seen in the C S F receive ampicillin or penicillin with an aminoglycoside than those in whom no organisms are seen.
Department of Medical Microbiology, Southmead Hospital, Westbury-on- Trym, Bristol Central Public Health Laboratory, 6I Colindale Avenue, London, U.K
A. P. MacGowan S. Y. McCulloch D. S. Reeves J. McLauchlin
References I. Mascola L, Sorvillo F, Lushley N, Steinberg E. Fatal listeria meningitis in an immunocompromised infant: therapeutic implications. J Infect I99 r ; z3: 287-29L 2. Hall CJ, Nelder C, Melville CAS. Listeriosis. Lancet I985; ii: 608.
II9
of treatment of shigellosis in adults and lends support to the observation made by Gotuzzo et al., 5 who found that single-dose treatment with norfloxacin for acute shigeUosis in adults is as effective as standard 5-day treatment with co-trimoxazole. Moreover, single-dose treatment has the advantage of being less expensive and promotes better patient compliance.
National Institute of Cholera and Enteric Diseases, P-33, C I T Road, Scheme X M , Beliaghata, Calcutta 7oooio, India and Infectious Diseases Hospital, Beliaghata, Calcutta 7oooio, India
I. 2. 3. 4. 5.
S. K. Bhattacharya M. K. Bhattacharya D. Dutta P. Durra M. Paul D. Sen S. Sarkar A. Saha (Chowdhury) S. C. Pal
References Pal SC. Epidemic bacillary dysentery in West Bengal, India, I984. Lancet I984; i: I462. Sen D, Dutta P, Deb BC, Pal SC. Nalidixic acid-resistant Shigella dysenteriae type I in eastern India. Lancet I988 ; ii: 9I I. Rogerio F, Ott D, Vandepitle J, Verbist L, Lemmens P, Habiyaremye I. Comparison of norftoxacin and nalidixic acid for treatment of dysentery caused by Shigella dysenteriae type I in adults. Antimicrob Agents Chemother I986; z9: 883-886. Bennish ML, Salam MA, Haider R, Barza M. Therapy for shigellosis. II. Randomized, double-blind comparison of ciprofloxacin and ampicillin. J Infect Dis I99o; 162:71 I - 7 I6. Gotuzzo E, Oberhelman RA, Maguina C et al. Comparison of single-dose treatment with norfloxacin and standard 5-day treatment with Trimethoprim-Sulfamethoxazole for acute shigellosis in adults. Antimicrob Agents Chemother I989; 33: I I o I - I I o 4 .
A n t i m i c r o b i a l c h e m o t h e r a p y o f m e n i n g i t i s due to Listeria monocytogenes in a d u l t s Accepted for publication I3 January I992 Sir, In a recent case report Mascola et al. 1 speculate on the use of second- and thirdgeneration cephalosporins in the treatment of listeria meningitis after describing infection of a black child in the U.S.A. in which G r a m - n e g a t i v e and positive rods were seen in the CSF. W e are at present conducting a retrospective survey of the treatment of adult listeria meningitis in the U . K . and early analysis has shown that I4 of 8o patients received a cephalosporin, usually cefotaxime, either in combination or singly as initial therapy before listeria had been cultured. T h e mortality was 4 / I 4 (28.6%) in patients receiving a cephalosporin as part of all of their initial therapy, 2/7 (28.6%) in those receiving cephalosporin m o n o t h e r a p y , and I 9 / 6 6 (28.8%) in patients who received other antimicrobials as initial treatment. N o patients were treated for listeriosis with a cephalosporin once the microbiological diagnosis had been made, usually within 24 h of C S F being taken. T w e n t y - o n e of 80 (26"2%) patients had organisms seen on G r a m - s t a i n e d films of C S F , and G r a m - p o s i t i v e bacilli were reported to be present in I4. I n two patients the laboratory suggested the diagnosis of listeriosis. T h r e e C S F s were reported as having G r a m - p o s i t i v e cocci suggestive of pneumococci, and G r a m - n e g a t i v e rods or cocci were seen in the remainder. One of these patients was being treated penicillin which m a y result in listeria appearing to be
I2o
Letters to the Editor
Gram-negative. 2 O f those with a positive Gram-stained film 47"6% ( I o / 2 I ) received 'gold standard' therapy of ampicillin or penicillin with gentamicin compared with I8"6% ( r i / 5 9 ) who did not (P < o'oi). However, this had no effect on mortality. Interestingly I o / 2 I (47'6%) of those with organisms seen in the film died compared with I2/59 (20%) of those in whom no organisms were seen (P < 0"05), perhaps because they were more severely ill. In conclusion, our preliminary data suggest cephalosporins are not widely used in the U.K. as first-line treatment of suspected bacterial meningitis and that while some problems exist in interpretation of Gram-stained films and responding therapeutically to such results, more patients with listeriosis and bacteria seen in the C S F receive ampicillin or penicillin with an aminoglycoside than those in whom no organisms are seen.
Department of Medical Microbiology, Southmead Hospital, Westbury-on- Trym, Bristol Central Public Health Laboratory, 6I Colindale Avenue, London, U.K
A. P. MacGowan S. Y. McCulloch D. S. Reeves J. McLauchlin
References I. Mascola L, Sorvillo F, Lushley N, Steinberg E. Fatal listeria meningitis in an immunocompromised infant: therapeutic implications. J Infect I99 r ; z3: 287-29L 2. Hall CJ, Nelder C, Melville CAS. Listeriosis. Lancet I985; ii: 608.
