Volume 87 Number 3

Letters to the Editor

Treatment of Pasteurella multocida meningitis To the Editor: We enjoyed reading the interesting article on Pasteurella multocida meningitis in a recent issue o f THE JOURNAL2 Two important points should be clarified so that future patients with such infections may be optimally treated. Penicillin sensitivity o f P. multocida is so constant that it has been proposed as a valuable aid in differentiating this organism from other gram-negative bacilli? Penicillin is clearly the drug of choice for patients who are not allergic to this drug? Sensitivity testing of the organism in the report confirmed its sensitivity to both penicillin and ampicillin. Ampicillin alone would have provided optimal therapy. The use of cephalothin added an unnecessary second drug, which has been shown to be inadequate in the treatment o f meningitis. 4. ~ Even the newer cephalosporins such as Cefazolin should not be used in meningitis, because they do not reliably enter the cerebrospinal fluid, despite high serum levels. 6, 7 Gerald W. Fischer, M.D. James W. Bass, M.D. Infectious Disease Section Department of Pediatrics Tripler Army Medical Center Honolulu, Hawaii 96819 REFERENCES

1. 2. 3.





Repice JP, and Neter E: Pasteurella multocida meningitis in an infant with recovery, J PEOIATR 86:91, 1975. DeBoar, RG, and Dumler, M: Pasteurella multocida infections. Report of 6 cases, Am J Clin Pathol 40:339, 1963. Holloway WJ, Scott EG, and Adams YB: Pasteurella multocida infection in man. Report of 21 cases, Am J Clin Pathol 51:705, 1969. Southern PM Jr, and Sanford JP: Meningococcal meningitis-suboptimal response to cephalothin therapy, N Eng J Med 280:1163, 1969. Mang RJ, Kundargi RS, Quintilian R, et al: Development of meningitis during cephalothin therapy, Ann Intern Med 78:347, 1973. Baker LH, Hinthorn DR, Romig DA, et al: Penetration o f cefazolin into CSF (Abstract 410), Program and Abstracts of the Fourteenth Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, California, Sept., 1974. Washington, D.C., 1974, American Society o f Microbiology. Lorber B, Santoro J, and Swenson RM: Listeria meningitis during cefazolin therapy, Ann Intern Med 82:226, 1975.

Rept] To the Editor: We fully agree with the comments of Drs. Fischer and Bass. Indeed, the extraordinary susceptibility of P. multocida to penicillin is even of diagnostic significance. That the favorable outcome in our patient, in all likelihood, can be ascribed to


ampicillin, was mentioned in the discussion. The addition of cephalothin was based on the facts that the strain proved to be very susceptible to this antibiotic and that the patient had two positive blood cultures. Joseph P. Repice, M.D. Erwin Neter, M.D. Department of Pediatrics State University of New York at Buffalo and Children's Hospital 219 Bryant St. Buffalo, N. ]q 14222

Treatment of protracted diarrhea in infancy To the Editor: Since Sherman and associates 1 have claimed such miraculous results for Vivonex, it would be interesting to know how many subjects actually fit the accepted definition of "severe intractable diarrhea,,~, 8: greater than 2 weeks o f diarrhea, onset at less than 3 months of age, and no evidence o f bacterial enteritis. Stanley Fisher, M.D. Division of Gastroenterology School o f Medicine University o f Pittsburgh Pittsburgh, Pa. 15261 REFERENCES

1. Sherman JO, Hamly C-A, and Khachadurian AK: Use of an oral elemental diet in infants with severe intractable diarrhea J PEOIATR 86:518, 1975. 2. Avery GB, Villavicencio O, Lilly JR, and Randolph JG: Intractable diarrhea in early infancy, Pediatrics 41:712, 1968. 3. Hyman CJ, Reiter J, Rodnan J, and Drash AL: Parenteral and oral alimentation in the treatment of nonspecific protracted diarrheal syndrome o f infancy, J P~OXATR 78:17, 1971.

Reply To the Editor: The information requested by Dr. Fisher is important and should have been included in our paper. Twenty-four of the 27 patients were 3 months o f age or younger. Three of these 24 patients had a bacterial enteritis. Fifteen of the remaining 21 patients had diarrhea for 2 or more weeks. All of these 15 patients responded favorably to treatment with the oral elemental diets. Therefore the elemental diets were 100% successful in those patients with diarrhea for longer than 2 weeks, with onset at 3 months o f age or younger, and with no evidence of bacterial enteritis.

Letter: Treatment of Pasteurella multocida meningitis.

Volume 87 Number 3 Letters to the Editor Treatment of Pasteurella multocida meningitis To the Editor: We enjoyed reading the interesting article on...
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