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In most developing countries,bacterial meningitis(BM)is associated with a high case-fatality rate.The search for a simple,convenient,and inexpensive antibiotic treatment remains a priority.In this study,a non-blinded, multicentre,randomised clinical trial of 528 cases of BM was done in two hospitals in Mali and Niger,between March,1989,and May,1990,to see whether a double injection of long-acting chloramphenical(on admission to hospital and 48 h later)is as effective as a course of intravenous ampicillin(8 days,4 times a day).the cumulative case-fatality rate on day 4(principal end-point)among the chloramphenical(254 patients)and ampicillin(274)groups were,respectively,28%and 24.5%(relative risk 1.14,95%confidence interval 0.86-1.52).No outbreak occurred during the study period.The hospital case- fatality rate was 33.1%.Main risk factors for death were associated with clinical condition on admission-ie,altered consciousness,convulsions,or dehydration.The case-fatality rates were 13%(21/161)for Neisseria meningitidis,36.1%(44.133)for Haemophilus influenzae,and 67%(77/115)for Streptococcus pneumoniae.In a multiple logistic regression model, controlling for the differential distribution of potential risk factors (including bacterial species),there was no difference between treatment groups.Our findings suggest that long-acting chloramphenicol is a useful first-line presumptive treatment for BM in high-incidence countries. |
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