Acute Bacterial Meningitis In Children Research Articles

Hearing loss in Malawian children after bacterial meningitis: incidence and risk factors

We had an objective to describe the incidence and risk factors for hearing loss following acute bacterial meningitis in children admitted to the Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. A double‐blind placebo‐controlled trial was designed from July 1997–March 2001 to determine whether early steroid therapy would reduce overall mortality and morbidity in childhood bacterial meningitis. The QECH, Blantyre, Malawi is a teaching and referral public hospital that serves the Blantyre area and receives referrals from throughout southern Malawi. Participants were children aged 2 months to 13 years, admitted with a diagnosis of bacterial meningitis, and the main outcome measures were mortality and morbidity following bacterial meningitis. Three hundred and ninety‐nine of 598 (66.7%) children survived; 33.6% were due to S. pneumoniae, 30% to Haemophilus influenzae type b, 15% to Neisseria meningitides, and 16% had no growth on CSF culture. Two hundred and sixty‐eight (67%) survivors had reliable hearing tests of whom 38% had impaired hearing, 77% of which was bilateral. Independent risk factors for hearing loss were the causative agent, presentation with a low coma score (52% vs. 34%, p = 0.006), a first CSF sample with a positive Gram stain for bacteria (65% vs. 44.3%, p = 0.003), a WBC < 100/cmm (p = 0.01), or a high protein level (50% if > 2000 mg/dl vs. 11% if <100 mg/dl). Associated neurological sequelae were highly associated with hearing impairment (p = 0.000012). We conclude that bacterial meningitis is the cause of many children's hearing impairment. Immunization against S. pneumoniae and H. influenzae would prevent many cases. Better first line antibiotics may reduce audiological damage. Deaf children in poorer parts of the world need more and vocal advocacy.

Acute bacterial meningitis in children admitted to a rural Kenyan hospital: increasing antibiotic resistance and outcome.

Acute bacterial meningitis (ABM) is an important cause of mortality in Africa, but most studies are based in urban referral hospitals. Poor laboratory facilities make diagnosis difficult, and treatment is limited to inexpensive antibiotics. We retrospectively reviewed data from children admitted with ABM to a Kenyan district hospital from 1994 through 2000. We calculated the minimum incidence in children admitted from a defined area. We also examined the antibiotic susceptibility patterns. We identified 390 cases (1.3% of all admissions) of whom 88% were <5 years old. The apparent minimum annual incidence in children younger than 5 years of age increased from 120 to 202 per 100,000 between 1995 and 2000 (P < 0.001). Increasing the lumbar punctures performed by including prostrated or convulsing children significantly increased the number of cases detected (P < 0.005). The most common organisms in infants <3 months were streptococci and Enterobacteriaceae. Streptococcus pneumoniae (43.1%) and Haemophilus influenzae (41.9%) were predominant in the postneonatal period. The overall mortality was 30.1%, and 23.5% of survivors developed neurologic sequelae. Chloramphenicol resistance of H. influenzae rose from 8% in 1994 to 80% in 2000 (P < 0.0001) accompanied by an apparent increase in mortality. A short history, impaired consciousness and hypoglycemia were associated with death. Prolonged coma and low cerebrospinal fluid glucose were associated with neurologic sequelae. ABM in rural Kenya is a severe illness with substantial mortality and morbidity. Prognosis could be improved by broadening the criteria for lumbar puncture and use of appropriate antibiotics.

Diagnosis of acute bacterial meningitis in children at a district hospital in sub-Saharan Africa

The diagnosis of acute bacterial meningitis in children is difficult in sub-Saharan Africa, because the clinical features overlap with those of other common diseases, and laboratory facilities are inadequate in many areas. We have assessed the value of non-laboratory tests and incomplete laboratory data in diagnosing childhood acute bacterial meningitis in this setting. We prospectively studied 905 children undergoing lumbar puncture at a rural district hospital in Kenya over 1 year. We related microbiological findings and cerebrospinal-fluid (CSF) laboratory measurements to tests that would typically be available at such a hospital. Acute bacterial meningitis was proven in 45 children (5.0% [95% CI 3.7-6.6]) and probable in 26 (2.9% [1.9-4.2]). 21 of the 71 cases of proven or probable acute bacterial meningitis had neither neck stiffness nor turbid CSF. In eight of 45 children with proven disease the CSF leucocyte count was less than 10x10(6)/L or leucocyte counting was not possible because of blood-staining. The presence of either a leucocyte count of 50x10(6)/L or more or a CSF/blood glucose ratio of 0.10 or less detected all but two of the 45 children with proven acute bacterial meningitis; these two samples were grossly blood-stained. The diagnosis of childhood acute bacterial meningitis is likely to be missed in a third of cases at district hospitals in sub-Saharan Africa without adequate and reliable laboratory resources. CSF culture facilities are expensive and difficult to maintain, and greater gains could be achieved with facilities for accurate leucocyte counting and glucose measurement.

Acute bacterial meningitis in children admitted to the Queen Elizabeth Central Hospital, Blantyre, Malawi in 1996-97.

To design appropriate interventions, we collected clinical and demographic data prospectively on all children aged one day to 14 years admitted with a diagnosis of bacterial meningitis (BM) from April 1st 1996 to March 31st 1997 to the Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. During the study period 267 children (2.7% of all paediatric admissions) were found to have BM; 83% were under 5 years of age, 61% under one year and 23% under one month. The most common causative organisms in the post neonatal period (n=206) were Streptococcus pneumoniae (27%), Haemophilus influenzae type b (Hib) 21%, and Salmonella typhimurium (6%). In the neonatal group (< 1 month, n=61) the most common causes were Streptococcus agalactiae (23%), S. typhimurium (15%), S. pneumoniae (11.5%) and other Gram negative rods (11.5%). Nineteen of 21 salmonella infections were in children under one year of age and all S. agalactiae were in infants under three months. There was delay on presentation: the average length of fever was 4.6 days, 39.5% had convulsed prior to arrival and 57% had an altered level of consciousness. An initial diagnosis of malaria had probably contributed to the delay in 22.5% (42 of 186 tested). 48% were < 80% weight for age, with 18% < 60%) weight for age. The overall mortality was 40%. The outcome was worst in salmonella infections, particularly neonatal salmonella BM with a case fatality rate (CFR) of 89% (8 of 9 cases). Coma on presentation worsened prognosis (mortality 64% if Blantyre Coma Score < 3, 26% if > 3). 15% of survivors had sequelae on discharge. 20% of Hib isolates were resistant to chloramphenicol, but all salmonellae were sensitive. 5% of S. pneumoniae were resistant to penicillin and 8% to chloramphenicol. Earlier access to adequate health care and awareness of BM in a malaria-endemic area would reduce mortality and morbidity. Vaccination against Hib infection would have reduced death by 18 (17%) and prevented sequelae in 7 cases.

Etiologyand occurrence of acute bacterial meningitis in children in Benghazi Libyan Arab Jamahiriya

Over a 14-month period, 77 children with a presumptive diagnosis of acute bacterial meningitis were investigated. The incidence of acute bacterial meningitis was 0.8%, with a case fatality rate of 13.0%. Children pound 1 year of age were more affected [64.9%]. The total male to female ratio was 1.2:1. Gram stain detected more cases [85.7%] than culture [66.2%]. A total of 48 isolates were identified by culture and their antibiotic sensitivity was determined. Haemophilus influenzae [33.8%] was the predominant organism identified, followed by Streptococcus pneumoniae [26.0%], Klebsiella spp. [6.5%] and Neisseria meningitidis [2.6%]. Many of the bacterial isolates were sensitive to gentamicin, cefotaxime and ceftriaxone and least sensitive to tetracycline and ampicillin

Acute Bacterial Meningitis in Children Admitted to the Queen Elizabeth Central Hospital Blantyre, Malawi in 1996-97

In order to design appropriate interventioos, we collected clinical and demographic data prospectively on all children aged one day to 14 years admitted with a diagnosis of bacterial meningitis (BM) from April 1st 1996 to March 31st 1997 to the Queen Elizabeth Central Hospital (QECH), Blantyre Malawi. During the study period 267 children (2.7% of all paediatric admissions) were found to have BM; 83% were under 5 years of age, 61 % under one year and 23% under one month. The most common causative organisms in the post neonatal period (n = 206) were Streptococcus pneumoniae (27%), Haemophilus influenzae type b (Hib) 21 %, and Salmonella typhimurium (6%). In the neonatal group «I month, n = 61) the most common causes were Streptococcus agalactiae (23%), S. typhimurium (15%), S. pneumoniae (11. 5%) and other gram negative rods (11.5%). Nineteen of 21 salmonella infections were in children under one year of age and all S. agalactiae were in infants under three months. There was delay on presentation: the average length of fever was 4.6 days, 39.5% had convulsed prior to arrival and 57% had an altered level of consciousness. An initial diagnosis of malaria had probably contributed to the delay in 22.5% , (42 of 186 tested). Forty eight percent were 3). Fifteen percent of survivors had sequelae on discharge. Twenty percent of Hib isolates were resistant to chloramphenicol, but all salmonellae were sensitive. Five percent of S. pneumoniae were resistant to penicillin and 8% to chloramphenicol. Earlier access to adequate health care and awareness of BM in a malaria endemic area would reduce mortality and morbidity. Vaccination against Hib infection would have reduced death by 18 (17%) and prevented sequelae in 7.

A glycoprotein pneumococcal conjugate vaccine primes for antibody responses to a pneumococcal polysaccharide vaccine in Gambian children.

Streptococcus pneumoniae is a major cause of acute respiratory infections and acute bacterial meningitis in children. Pneumococcal polysaccharide vaccines are poorly immunogenic in this highly vulnerable group, but protein polysaccharide conjugate vaccines are likely to be more effective. To determine whether immunization of infants with a pneumococcal conjugate vaccine induces immunologic memory. Eighty-four Gambian children, who had been vaccinated previously with two or three doses of a pentavalent pneumococcal conjugate vaccine (CRM197) or with a Haemophilus influenzae type b (Hib) conjugate vaccine were immunized when approximately 2 years old with a 23-valent pneumococcal polysaccharide vaccine, and a blood sample was obtained 10 days later. Pneumococcal antibody titers in prevaccination and postvaccination sera were measured by enzyme-linked immunosorbent assay and by an opsonophagocytic assay. On revaccination with a pneumococcal polysaccharide vaccine, children who had previously received pneumococcal conjugate vaccine had higher antibody concentrations to each of the five polysaccharide components of the conjugate vaccine than did control children. For type 6B polysaccharide, which is poorly immunogenic in young children, postvaccination antibody concentrations were 0.37, 27.6 and 50.9 microg/ml in children who had received no previous pneumococcal immunization or two or three doses of conjugate vaccine, respectively. Type 14 antibodies produced after revaccination were of high avidity and had opsonic activity. Vaccination of young infants with two or three doses of a pneumococcal conjugate vaccine primes the immune system to respond strongly and rapidly on subsequent exposure to pneumococcal polysaccharide.

In vitro antibiotic sensitivity pattern of common bacterial isolates from cases of acute bacterial meningitis with special reference to ceftriaxone.

Ceftriaxone (RO 13-9904) has only recently been introduced in Benghazi and many parts of the word. We determined its in-vitro antibacterial activity against the primary aetiological agents of childhood meningitis in Benghazi, that included eighteen (23.3%) strains of H. influenzae, 17 (22.1%) of Str. pneumoniae and 1 (1.3%) of N. meningitidis isolated from 77 cases of acute purulent meningitis above the age of neonatal period. All strains of H. influenzae. Str. pneumoniae and N. meningitidis were sensitive to ceftriaxone and showed wide zones of inhibition by the disc diffusion technique of Kirby-Bauer. Ampicillin and chloramphenicol resistance was observed for H. influenzae (23% and 11% respectively), and Str. pneumoniae (12% and 0% respectively), in addition, 18% of strains of Str. pneumoniae showed resistance to penicillin. The broad spectrum activity of ceftriaxone has been confirmed for our locality and this finding, together with its exceptionally long half-life, excellent penetration into the C.S.F. and ease of administration (single daily dose) warrants it as the drug of choice in empherical treatment of cases of acute bacterial meningitis in children in Benghazi and in cases where resistance to ampicillin and chloramphenicol are found on subsequent testing.

4-04-09 Intra-hospital lethality of acute bacterial meningitis in children

4-04-09 Intra-hospital lethality of acute bacterial meningitis in children

Serotype distribution and antibiotic susceptibility of Streptococcus pneumoniae isolates causing systemic infections among children in Germany, 1992 to 1996.

Serotype distribution and antibiotic susceptibility of Streptococcus pneumoniae isolates causing systemic infections among children in Germany, 1992 to 1996.

Long-term follow-up of acute bacterial meningitis in children

Long-term follow-up of acute bacterial meningitis in children

Infections of the Central Nervous System

Part 1 Viral infections of the central nervous system and related disorders: pathogenesis and pathophysiology of viral infections of the central nervous system, M. Schlitt et al viral meningitis and the aseptic meningitis syndrom, H.A. Rotbart encephalitis caused by herpesviruses, including B virus, R.J. Whitley and M. Schlitt arthropod-borne encephalitides, R.J. Whitley meningitis and encephalitis caused by mumps virus, J.W. Gnann, Jr et al slow viral infections of the human nervous system, D.M. Asher perinatal viral infections R.J. Whitley and S. Stagno neurological manifestations of infection with the human immunodeficiency viruses, B.K. Evans et al viral vaccines that protect the central nervous system, M.F. Mangano and S.A. Plotkin Guillain-Barre syndrome, G. Tenorio et al. Part 2 Mycoplasmal infections of the central nervous system: mycoplasmal diseases of the central nervous system, W.A. Clyde, Jr. Part 3 Bacterial infections of the central nervous system: pathogenesis and pathophysiology of bacterial infections of the central nervous system, A.R. Tunkel and W.M. Scheld neonatal bacterial meningitis, A.L. Smith and J. Haas acute bacterial meningitis in children and adults, K.L. Roos et al rickettsiae and the central nervous system, J.H. Kim and D.T. Durack tuberculosis of the central nervous system, A. Zuger and F.D. Lowy brain abscess, B. Wispelwey et al subdural empyema, D.C. Hefgott et al epidural abscess, B.G. Gellin et al central nervous system complications of infective endocarditis, P. Francioli infections of the cerebrospinal fluid shunts, B.A. Kaufman and D.G. McLone. Part 4 Central nervous system syndromes mediated by bacterial toxins: botulism, J.M. Hughes tetanus, T.P. Bleck bordetella pertussis and the central nervous system, E.L. Hewlett. Part 5 Spriochetal infections of the central nervous system: central nervous system syphilis, E.W. Hook, III Lyme disease, L. Reik, Jr. Part 6 Fungal infections of the central nervous system: pathogenesis and pathophysiology of fungal infections, J. R. Perfect and D.T. Durack chronic meningitis, T. Tucker and J.J. Ellner diagnosis and treatment of fungal meningitis, J.R. Perfect space-occupying fungal lesions of the central nervous system, K. Sepkowitz and D. Armstrong. Part 7 Protozoal and helminthic infections of the central nervous system: protozoal infections, J.P. Cegielski and D.T. Durack toxoplasmosis, C.S. Dukes et al helminthic infections, M.L. Cameron and D.T. Durack.

Long term sequelae of childhood acute bacterial meningitis in a developing country: A study from the sudan

35 survivors of acute bacterial meningitis (ABM) from a group of 44 Sudanese children--seen during 18 months (April 1985-November 1986)--were prospectively followed to ascertain the long-term sequelae of the disease. 30 (17 with Haemophilus influenzae, 8 Neisseria meningitidis, 4 Streptococcus pneumoniae and one child with Enterobacter cloacae meningitis) could be followed during the surveillance period (3-4 years). Three (10%), including 2 with hemiplegia, died after 11-12 months. The association between motor deficit on discharge from hospital and subsequent death was significant (p = 0.04). Of the remaining 27, neuropsychologic sequelae were recorded in 9 (33%). Sensorineural hearing loss was observed in 6 (22%) patients and improved in one during surveillance. Motor deficits were found to improve with time but were replaced by the development of epilepsy about 3 years later in 11% of the survivors. The mean IQ (+/- SD) score for a subgroup of 19 post-meningitic children (92.3 +/- 13.9) was found to be significantly lower than in their nearest-age sibling controls (100.7 +/- 10.2; p = less than 0.01). Younger age at admission and longer duration of ABM symptoms before treatment were significantly associated with poorer outcome (respectively, r = 0.63, p = less than 0.01, r = 0.67, p = less than 0.01). The potential impact of vaccination against the commonest organisms causing ABM in developing countries is discussed.

Short course single daily ceftriaxone monotherapy for acute bacterial meningitis in children: Results of a Swiss multicenter study. Part I: Clinical results

In a prospective Swiss multicenter study, 119 children (aged three weeks to 15.5 years) with acute bacterial meningitis were treated with single daily doses of ceftriaxone (100 mg/kg on days one and two and 60 mg/kg thereafter). All patients were randomly assigned to either short course (four, six, seven days) or full course (eight, 12, 14 days) therapy depending on whether they had contracted meningococcal, Haemophilus influenzae type b or pneumococcal meningitis. Bacteriological cure was obtained in 92 children who fully completed the study and in all the 20 culture-positive of the 27 children secondarily excluded from the study for failure to meet all bacteriological and initial safety criteria for continuation in protocol (secondary exclusions). Complete clinical recovery was noted in 105 of 119 patients (88%) and was as frequent in the short course (91%) as in the full course (89%), and as in the secondary exclusion (81%) group. All patients survived. At follow-up examination three to six months after hospital discharge only seven infants and seven children (11.8%), mostly those with poor presentation on admission (p = 0.0012), showed residual neurological sequelae. Side effects of antibiotic therapy were minor but more frequent, albeit not statistically significant (p = 0.065), in children receiving the full course therapy. The results of this study suggest that short course treatment of acute bacterial meningitis in children with single daily ceftriaxone monotherapy is as efficacious as full course therapy and at least as well tolerated.

Short course single daily ceftriaxone monotherapy for acute bacterial meningitis in children: Results of a Swiss multicenter study. Part II: Bacteriological results

The in vitro activity of ceftriaxone, ampicillin and chloramphenicol was studied at a reference laboratory against the isolates of the first 33 patients enrolled in a pediatric Swiss Multicenter Meningitis Study. The predictive value of the MIC data of 31 of the strains was further corroborated by two sets of bacterial killing curves in broth supplemented with 2 g/l of albumin. Ceftriaxone had the lowest geometric mean MIC values against all groups of isolates except for ampicillin against Streptococcus agalactiae. The bactericidal activity of ceftriaxone and that of ampicillin, alone and in combination with chloramphenicol, was compared at six times the respective MICs and at pharmacologically readily achievable concentrations in cerebrospinal fluid. The bactericidal power of ceftriaxone at six times the MIC was as good or better than that of ampicillin alone or in combination against Neisseria meningitidis and Streptococcus pneumoniae despite the very low drug concentrations of ceftriaxone compared to that of the competitors; and it was barely lower at six times the MIC and at 1 mg/l (a level that is readily surpassed in CSF at the 24 h trough level after a single daily dose of ceftriaxone of 100 mg/kg (neonates 50 mg/kg) than that of ampicillin and chloramphenicol at much higher concentrations against Haemophilus influenzae type b.

Childhood Acute Bacterial Meningitis in the Suda: An Epidemiological, Clinical and Laboratory Study

The aims of the present study were to document the epidemiology, clinical features and complications of childhood acute bacterial meningitis (ABM) in The Sudan during both an inter-epidemic (endemic) period (1985-1986), and the 1988 serogroup A epidemic; and to examine the phenotypic and genetic similarities and differences of Neisseria meningitidis strains isolated in The Sudan and Sweden. A new enzyme immunoassay test (Pharmacia Meningitis EIA-Test) was evaluated as a potential rapid diagnostic method for the detection of Haemophilus influenzae (HI) type b, Neisseria meningitidis (MC) and Streptococcus pneumoniae (PNC). The test was found to have good sensitivity (0.86) and specificity (0.95) in the inter-epidemic period; and to be adaptable to the field work in The Sudan during the 1988 MC epidemic. During inter-epidemic (endemic) situations in The Sudan, greater than 90% of childhood ABM was caused by one of the three organisms, HI type b, MC and PNC. HI accounted for 57% of the cases. The peak incidence (76%) of HI cases was in infants (less than 12 months) similar to the situation in other African countries. The overall case fatality ratio was 18.6%. Prospective follow-up of survivors for 3-4 years revealed that an additional 43% either died or had permanent neurological complications, the most prevalent and persistent of which was sensorineural hearing loss recorded in 22% of long term survivors. Post-meningitic children were found to have significantly lower intelligence quotients (92.3 +/- 13.9) than their sibling controls (100.7 +/- 10.2, P = 0.029). Features of the large serogroup A sulphonamide resistant MC epidemic (February-August 1988) in Khartoum are described. An estimated annual incidence of 1,679/100,000 was recorded at the peak of the epidemic. The highest attack rate was in young children less than 5 years, as in many other African countries; nevertheless, a high morbidity was observed in adults (31% of the cases greater than or equal to 20 years). The clinical features, mortality (6.3%) and short term sequelae in Sudanese children were generally within the framework described for MC disease elsewhere. Detailed analysis of MC isolates from Sudan and Sweden by characterizing their electrophoretic enzyme types, DNA restriction endonuclease pattern and outer membrane proteins, revealed that serogroup A MC clone III-1 was responsible of The Sudan epidemic in 1988 and has been the dominant serogroup A organism in Sweden since 1973. The Sudanese strains isolated prior to the epidemic (1985) were clone IV-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Sequelae of Acute Bacterial Meningitis in Children Treated for Seven Days

The sequelae of acute bacterial meningitis in children who were treated with ampicillin or chloramphenicol for seven days during the period January 1979 to June 1983 were assessed prospectively. The 235 patients (117 boys and 118 girls) ranged in age from four days to 18 years (mean 26.4 months). Haemophilus influenzae type b was isolated in 70% of patients, Streptococcus pneumoniae in 20%, and Neisseria meningitidis in 10%. The mortality rate was 6.4%. No relapses occurred. Of the 220 survivors, 171 had neurologic psychometric, audiologic, and ophthalmologic assessments performed for a minimum of 1 year following their illness. One hundred thirty-six (80%) children had no detectable sequelae; 20% had mild to severe handicaps. The frequency of sequelae was greatest among children with S pneumoniae meningitis (57%) and least among children with N meningitidis (0%). The sequelae observed included: sensorineural hearing loss (12.9%), developmental delay (5.3%), speech defect (4.7%), motor defect (3.0%), hydrocephalus (1.7%), and seizure disorder (1%). The frequency of observed sequelae among these patients is similar to that previously reported in children treated for ten to 14 days. Our findings indicate that seven days of intravenous antibiotic therapy is adequate for the treatment of bacterial meningitis in children.

Acute Bacterial Meningitis in Children and Adults: A Perspective

Bacterial meningitis is an acute and serious illness associated with significant morbidity and mortality. Although methods to make the diagnosis are relatively simple and effective antimicrobial agents are available, bacterial meningitis accounts for more than 2000 reported deaths per year in the United States. The majority of cases and deaths occur in otherwise healthy individuals.

Prospective evaluation of hearing impairment as a sequela of acute bacterial meningitis.

As part of a prospective study of acute bacterial meningitis in children, we studied for five years the hearing of 185 infants and children who had acute bacterial meningitis when they were more than one month of age. Nineteen (10.3 per cent) of the patients had persistent bilateral or unilateral sensorineural hearing loss. The incidence of hearing loss as determined by electric-response audiometry and conventional tests was 31 per cent with Streptococcus pneumoniae, 10.5 per cent with Neisseria meningitidis, and 6 per cent with Hemophilus influenzae infections. Transient conductive hearing impairment was found in 16 per cent of the sample, but in no case was there apparent improvement in a sensorineural deficit over time. The site of disease resulting in impaired hearing cannot be stated with certainty, but involvement of the inner ear or auditory nerve was suspected. The number of days of illness (symptoms) before hospitalization and institution of antibacterial treatment was not correlated with the development of sensorineural deafness.

CEFUROXIME VERSUS AMPICILLIN AND CHLORAMPHENICOL FOR THE TREATMENT OF BACTERIAL MENINGITIS: Report from a Swedish Study Group

In a prospective randomised multicentre study cefuroxime was compared with a combination of ampicillin and chloramphenicol in the treatment of 50 consecutive patients with acute bacterial meningitis, in 40 of whom the bacterial aetiology was proven by cerebrospinal-fluid (CSF) cultures. Excellent clinical results were obtained in 18 of 21 evaluable patients treated with cefuroxime and in 14 of 19 evaluable patients treated with ampicillin and chloramphenicol. The meningitis was caused by Haemophilus influenzae in 20 of the evaluable patients, by meningococci in 11, by pneumococci in 5, and by other bacterial species in 4. Two of the H. influenzae strains were β-lactamase producing, and the 2 patients infected with these strains, 1 in each treatment group, were cured. 4 of the patients died from their infections. 3 of these patients, 1 in the cefuroxime group and 2 in the ampicillin plus chloramphenicol group, were children who were admitted in extremely poor condition. The 4th patient had a staphylococcal abscess in the hip which was not recognised and drained. He recovered from his meningitis but died from brain abscesses. In 1 patient in the cefuroxime group and 2 patients in the ampicillin plus chloramphenicol group there was incomplete resolution of symptoms or complications had developed by the end of the treatment period. At follow-up 6 weeks after the end of the treatment period 1 patient in the cefuroxime group showed a hearing defect not noted on discharge from hospital. No serious adverse reactions were noted. Determination of CSF and serum concentrations of cefuxomime 6–12 h after a dose showed a high degree of penetration of cefuroxime through the blood-CSF barrier. Cefuroxime is an alternative for treatment of acute bacterial meningitis in children and adults.