A 10-year-old child is brought with suspected meningococcal meningitis. The physician wants to prescribe a 3rd-generation cephalosporin. Which cephalosporin is PREFERRED for bacterial meningitis, and why?
- A Ceftriaxone; because it achieves adequate CSF penetration with inflammation and has excellent gram-negative coverage ✓
- B Cefazolin; because it achieves the highest CSF penetration among all cephalosporins
- C Cefuroxime; because it has superior activity against penicillin-resistant pneumococcus
- D Cefepime; because its broader anti-pseudomonal coverage adds empiric protection
Correct answer: A. Ceftriaxone; because it achieves adequate CSF penetration with inflammation and has excellent gram-negative coverage
Explanation
Ceftriaxone (3rd generation) and cefotaxime are the preferred cephalosporins for bacterial meningitis because they achieve therapeutic CSF levels (especially when meninges are inflamed), have excellent activity against the major meningeal pathogens (N. meningitidis, S. pneumoniae, H. influenzae), and have a long half-life allowing twice-daily dosing. Cefazolin (1st generation) has minimal CSF penetration and limited gram-negative coverage. Cefuroxime is actually associated with delayed sterilization in pneumococcal meningitis and is not preferred.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.