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In 201 clinical isolates the antibacterial activity of (2S,5R, 6R)-6-[(R)-2-(4-Hydroxy-1,5-naphthyridine-3-carboxamido) -2-phenylacetamido]-3,3-dimethyl-7-oxo-4-thia-1-azabicyclo [3.2.0]heptane-2-carbonic acid (apalcillin, PC-904) a new semisynthetic broad spectrum penicillin, was tested. The activity was almost equal to piperacillin, the at present optimal penicillin derivative, but against pseudomonas apalcillin was clearly superior. Lack of activity as compared to the acylureidopenicillins was found in proteus species whilst its activity against E. coli and klebsiella species was higher. Antagonism was observed in pseudomonas aeruginosa for the combination of apalcillin and cefoxitin which also existed with azlocillin or piperacillin and cefoxitin.

For the specific and unspecific treatment of purulent meningitis, penicillin, ampicillin and chloramphenicol are usually sufficient. Only resistant pathogens (Klebsiella, Pseudomonas among others) and meningitis in infants require other treatment. Cephalosporins and aminoglycosides only come into consideration for the treatment of very rare exceptional cases. The still relatively poor prognosis of purulent meningitis is largely independent of the efficacy of the treatment. Delay in beginning therapy, lack of intensive care, primary diseases and complications are principally responsible for this. Medicamentous prophylaxis is only possible for meningococcal meningitis. The distribution of antibiotics in the CSF is irregular. Also the antibacterial activity in the CSF is different from culture media.