Bacterial meningitis in India: An IJP survey

Abstract

It can be concluded that bacterial meningitis is an important cause of childhood morbidity and mortality. Isolation of causative pathogenes is poor in our country. A routine gram staining of CSF and use of rapid diagnostic kits with better culture facilities would be helpful in improving the outcome. In first 3 months of life, therapy should include one of the 3rd generation cephalosporins with an aminoglycoside. For meningitis in age groups between 3 months to 12 years, chloramphenicol and ampicillin should be the first line empirical therapy. If gram-ve organisms are suspected or isolated, one of the 3rd generation cephalosporins with or without an aminoglycoside is good alternative. The treatment can be stopped in uncomplicated case after 7–10 days (5 days of afebride period) in meningitis caused by meningococcus, pneumococcus andH. infuenzae. For BM caused by gram-ve bacilli treatment for 21 days is recommended. There is no need to perform CSF examination at the conclusion of therapy in cases of bacterial meningitis beyond neonatal period. There is a need to further evaluate therapeutic regimens like chloramphenicol alone, ceftriaxone home therapy, especially for rural areas etc. to decrease the cost of hospitalisation in referral hospitals.