A Cochrane review [Abstract] 1 included 19 studies with a total of 1 496 subjects. The empirical experimental treatment was ceftriaxone in 16, cefotaxime in two and ceftazidime in one trial. The empirical control treatment was ampicillin plus chloramphenicol in nine, ampicillin plus chloramphenicol plus gentamicin in three, benzylpenicillin plus chloramphenicol in two, ampicillin alone in two, benzylpenicillin alone in two, and oily injection of chloramphenicol in one trial. Only four studies included adults, of which two were restricted to participants older than 15 years of age. Ten studies were from low to middle income countries and nine from high income countries. All the studies were conducted in the1980s except three, which were reported in 1993, 1996, and 2005. There was no statistically significant difference between the groups in the risk of death (risk difference RD 0%; 95% CI -3% to 2%), risk of deafness (RD -4%; 95% CI -9% to 1%), or risk of treatment failure (RD -1%; 95% CI -4% to 2%). However, there were significantly decreased risks of culture positivity of CSF after 10 to 48 hours (RD -6%; 95% CI -11% to 0%) and statistically significant increases in the risk of diarrhoea between the groups (RD 8%; 95% CI 3% to 13%) with the third generation cephalosporins. The risk of neutropaenia and skin rash were not significantly different between the two groups.
Comment: The quality of evidence is downgraded by indirectness (differences in studied patients, possible resistance changes in causative microbes since the time the studies were conducted).
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