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Hundred and fifteen children suffering of purulent meningitis (S.pneumoniae: 19; H.influenzae: 44; N.meningitidis; 23; others: 29) were treated by amoxicillin 200 mg/kg/day in four intramuscular injections. Spinal taps for assay of antibiotic levels in the CSF were taken 1 or 3 or 6 hours after the injection. The levels were respectively for this samples of 6.9 -1.7-1.4 micrograms/ml during the first 48 hours of treatment and 4.4-1.7-1.9 after one week. The concentrations CSF/serum were from 5 to 9.8 per cent at the beginning of treatment.

The pharmacokinetics of amoxycillin in the CSF following intravenous and oral administration at a 150 mg/kg per day or 250 mg/kg per day dosage in the treatment of purulent meningitis is described. A significant correlation between meningeal inflammation and CSF levels of amoxycillin were observed, including a correlation between the initial neurological state and the outcome of the illness. Despite the early introduction of oral therapy and the reduction in dosage following meningeal and pneumococcal meningitis, no treatment failures could be attributed to this therapeutic regime. Such a treatment schedule, moreover, reduces the risk of superinfection in hospital as well as the cost of treatment and aids the comfort to the patient.

Amoxicillin and ampicillin levels were comparatively studied in blood and CSF of children with purulent meningitis. Thirty one children aged 2 months to 11 years were treated by one of two beta lactams by monotherapy in a daily dose of 200 mg/kg (Group 1: amoxicillin, n = 17; group 2: ampicillin, n = 14). Samples were collected on day 2 one hour after administration of 50 mg/kg IV of the chosen antibiotic. The mean levels observed in serum (69.5 and 53.4 micrograms/ml) and in CSF (7.74 and 7.96) were not significantly different. Beyond these levels we studied different biologic parameters in CSF: leucocytes, polymorphonuclears, protein, glucose and lactic acid. Multiple linear correlations were found, for the two groups and for the whole population between the CSF antibiotic level and the 6 other parameters (group 1: R1 = 0.82; group 2: R2 = 0.88; group 1 + 2: R3 = 0.78). The best correlated parameters with antibiotic CSF level are serum antibiotic level and CSF lactic acid. With these two parameters we can also estimate antibiotic level in CSF with good correlations (R1 = 0.78; R2 = 0.72 and R3 = 0.72).