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Glycerol and Acetaminophen as Adjuvant Therapy Did Not Affect the Outcome of Bacterial Meningitis in Malawian Children

Molyneux, Elizabeth M. FRCPCH*; Kawaza, Kondwani FCSA*; Phiri, Ajib MMed*; Chimalizeni, Yamikani MMed*; Mankhambo, Limangeni MMed*; Schwalbe, Edward PhD; Kataja, Matti; Pensulo, Paul Dip Clin Med*; Chilton, Lucy PhD; Peltola, Heikki MD§

The Pediatric Infectious Disease Journal: February 2014 - Volume 33 - Issue 2 - p 214–216
doi: 10.1097/INF.0000000000000122
Brief Reports

We investigated the benefit of 2 candidate adjunctive therapies in bacterial meningitis: glycerol, which has shown promise in earlier studies, and acetaminophen, which is reportedly beneficial in adult septicemia. In a hospital in Blantyre, Malawi, we enrolled 360 children aged ≥ 2 months with proven bacterial meningitis (36% HIV infected) in a double-blind, randomized, placebo-controlled trial of glycerol and acetaminophen in a 2 × 2 factorial design. Of 4 groups, first group received oral glycerol, second received rectal acetaminophen, third received both therapies and the fourth received placebos only. Adjuvant therapies were given for the first 48 hours of antibiotic therapy. Endpoints were mortality and neurological sequelae. Baseline findings were similar across all groups, except that many children had prior antibiotics in the acetaminophen group and many were anemic in the acetaminophen and glycerol group. Outcomes were similar for all groups. We found no benefit from oral glycerol or rectal acetaminophen in, mostly pneumococcal, meningitis in Malawian children.

From the *Department of Pediatrics and Child Health, College of Medicine, Malawi; Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK; National Institute for Health and Welfare; and §Children’s Hospital, Helsinki University Central Hospital, Helsinki, Finland.

Accepted for publication July 31, 2013.

Authors’ contribution: H.P. designed the study, E.M., K.K., Y.C., E.C., P.P. cared for patients, E.M. was responsible for data and L.C. and M.K. did analyses. All authors had access to study data. E.M. wrote the first draft and all authors contributed to and approved the final draft. Tables of detailed results are available from the authors.

The study received funding from the Academy of Finland. The authors have no other funding or conflicts of interest to declare.

Address for correspondence: Elizabeth M. Molyneux, Department of Pediatrics and Child Health, College of Medicine, Box 360, Blantyre, Malawi. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.