van de Bor M, Westdorp J M, Vossen J M
Tijdschr Kindergeneeskd. 1981 Dec;49(6):189-99.
One hundred and seventyeight children above the age of three months were treated for purulent meningitis (68 X N.meningitidis, 60 X H.influenzae, 19 X D.pneumoniae, 9 X other bacteria and 22 X with negative culture results) with a combination of either two or three antimicrobial drugs i.e. penicillin, sulphonamides and chloramphenicol, according to the causative microorganisms. The number of deaths was four (2%). Early neurological complications were seen in two (1%) and severe long-term sequelae in one (0.6%) of the patients. Antagonism between chloramphenicol and penicillin was not found in vivo, probably because the level of the latter drug was too low in the cerebrospinal fluid. These results contrast favourable with those after single-drug treatment i.e. with ampicillin, as reported in the literature. A possible explanation for this finding is the low level of beta-lactam antibiotics in the cerebrospinal fluid and the emergence of strains of H.influenzae and D.pneumoniae insensitive to such levels.
