Bacterial Meningitis In Infants Research Articles

Cefotaxime versus penicillin-choramphenicol in purulent meningitis: a controlled single-blind clinical trial

In a prospective, controlled, randomized single-blind clinical trial, treatment with cefotaxime (CTX) was compared with that with standard therapy (ST), which consisted of a penicillin-chloramphenicol combination with or without sulphadiazine, in 31 patients (excluding neonates) with proven bacterial meningitis. The two groups of patients were comparable in age, sex, clinical presentation and causative pathogens. The case fatality rate was 12.5% for the CTX group and 20% for the ST group, but this difference was not significant. The times taken for the cerebrospinal fluid (CSF) to become sterile and the temperature to normalize, the mean duration of treatment, complications and adverse effects were similar for the two regimens. Neurological or developmental abnormalities on follow-up were not significantly different for the two groups. It is concluded that CTX is a suitable alternative for treatment of bacterial meningitis in infants and children.

Use of dexamethasone for treatment of bacterial meningitis in infants and children

Use of dexamethasone for treatment of bacterial meningitis in infants and children

Use of dexamethasone for treatment of bacterial meningitis in infants and children

Use of dexamethasone for treatment of bacterial meningitis in infants and children

Consensus report

McCRACKEN, GEORGE H. JR. MD; NELSON, JOHN D. MD; KAPLAN, SHELDON L. MD; OVERTURF, GARY D. MD; RODRIGUEZ, WILLIAM J. MD; STEELE, RUSSELL W. MD Author Information

Cefotaxime for treatment of gram-negative bacterial meningitis in infants and children.

Cefotaxime for treatment of gram-negative bacterial meningitis in infants and children.

Bacterial meningitis in infants: sonographic findings.

A retrospective study was performed on 78 patients (newborn to 2 years old) with clinically proved bacterial meningitis. Sonograms were obtained during the acute illness and medical records were reviewed. The spectrum of sonographic features of meningitis included normal scans (30 patients), ventriculomegaly (11 patients), echogenic sulci (31 patients), extra-axial fluid collections (26 patients), abnormal parenchymal echogenicity (9 patients), evidence of ventriculitis (5 patients), and brain abscess (1 patient). In 46 patients, correlation between the sonographic findings and neurologic outcome on clinical follow-up (6 months to 4 years) was made. Findings of abnormal parenchymal echogenicity and/or moderate-to-marked ventriculomegaly were associated with significant neurologic sequelae; however, echogenic sulci and small extra-axial fluid collections did not appear to have any prognostic significance. Twenty-nine of the 78 patients had sonography without clinical indication of complications of meningitis, and in no patient was a significant abnormality found. Our study suggests that sonography is indicated only when there is clinical suspicion of complications.

Management of bacterial meningitis i current status and future prospects

Outcome from bacterial meningitis in infants and children has not appreciably changed in a 14-year period from 1969 to 1982 at Children's Medical Center and Parkland Memorial Hospital, Dallas, Texas. Overall, the case-fatality rate was 6.4 percent; it was 4.6 percent for 414 patients managed in 1969 to 1972 and 3.9% for 376 patients in 1981 and 1982. In neonatal meningitis due to group B streptococci or coliform bacilli, the fatality rates were comparable in 1969 to 1972 and 1981 and 1982; ampicillin and an aminoglycoside were the mainstays of therapy during these periods. Because of changing susceptibilities of gram-negative enteric bacilli to the aminoglycosidic agents, Haemophilus influenzae to ampicillin and possibly chloramphenicol and of Streptococcus pneumoniae to penicillin, alternatives to conventional therapy must be developed and thoroughly tested. Assessment of new antimicrobial agents in the rabbit model of experimental meningitis provides valuable information on penetration of drug into cerebrospinal fluid, on achievable bactericidal activity in spinal fluid and on the bacteriologic effect of single dose or nine hour infusion therapy. These data are directly applicable to therapy in infants and children with meningitis. Although newer antimicrobial agents such as moxalactam, cefotaxime, or ceftriaxone have greatly enhanced bactericidal activity against the commonly encountered pathogens, outcome from meningitis will not be substantially improved with therapy using these agents. Improved outcome will more likely occur with the advent of therapeutic modalities that prevent or rapidly decrease cerebral edema and cerebritis, thereby preserving cerebral perfusion pressure and cellular integrity.

Cefuroxime Treatment of Bacterial Meningitis in Infants and Children

Cefuroxime Treatment of Bacterial Meningitis in Infants and Children

Cefuroxime treatment of bacterial meningitis in infants and children.

Recently, ampicillin- and chloramphenicol-resistant strains of Haemophilus influenzae type b and multiply-resistant Salmonella strains have appeared in some areas of the world. Therefore, alternative drug therapy for infections caused by these organisms is being sought. We used cefuroxime to successfully treat five children with H. influenzae type b meningitis and two children with Salmonella meningitis. Four H. influenzae type b isolates and one Salmonella isolate were resistant to ampicillin, chloramphenicol, and cotrimoxazole. Each of the patients received 200 to 250 mg of cefuroxime per kg per day in four divided doses for 14 to 21 days. The concentrations of cefuroxime in cerebrospinal fluid at 2 h after intravenous 50-mg/kg doses were 6.4 +/- 1.7 (mean +/- standard deviation) and 3.6 +/- 2.2 micrograms/ml on days 2 and 14 of treatment, respectively. The level of drug in cerebrospinal fluid was 1.34 +/- 1.3 micrograms/ml in children without meningitis. The mean cefuroxime concentration in subdural fluid samples from each of three patients was 12.6, 15, and 25.2 micrograms/ml. Cefuroxime is recommended as an alternative drug for the treatment of H. influenzae type b meningitis, but additional information is necessary before cefuroxime can be recommended for therapy of Salmonella meningitis.

Bacterial meningitis in infants and children.

Bacterial meningitis of infants and children exact a major toll worldwide. Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis continue to be the major causes, and efforts to reduce the incidence of this disease have had limited success. Major advances in rapid diagnosis, such as antigen detection, have occurred over the past several decades; however, Gram stain, cytologic examination and culture of the CSF remain the most reliable means of making an etiologic diagnosis. Despite shifts in bacterial susceptibilities to commonly used antibacterial agents, penicillin, ampicillin and chloramphenicol remain effective therapy for the vast majority of cases, although newer cephalosporin derivatives may be required to avoid the toxicities of chloramphenicol and to effectively treat selected bacteria that have developed resistance to these more classical antibiotics. The prognosis for bacterial meningitis in infants and children remains guarded because of late diagnosis and the severity of the disease. Major reductions in the incidence of the disease will depend on definition of high-risk populations and application of appropriate preventions.

Clinical pharmacokinetics of chloramphenicol and chloramphenicol succinate.

In recent years there has been a renewal of interest in chloramphenicol, predominantly because of the emergence of ampicillin-resistant Haemophilus influenzae, the leading cause of bacterial meningitis in infants and children. Three preparations of chloramphenicol are most commonly used in clinical practice: a crystalline powder for oral administration, a palmitate ester for oral administration as a suspension, and a succinate ester for parenteral administration. Both esters are inactive, requiring hydrolysis to chloramphenicol for anti-bacterial activity. The palmitate ester is hydrolysed in the small intestine to active chloramphenicol prior to absorption. Chloramphenicol succinate acts as a prodrug, being converted to active chloramphenicol while it is circulating in the body. Various assays have been developed to determine the concentration of chloramphenicol in biological fluids. Of these, high-performance liquid chromatographic and radioenzymatic assays are accurate, precise, specific, and have excellent sensitivities for chloramphenicol. They are rapid and have made therapeutic drug monitoring practical for chloramphenicol. The bioavailability of oral crystalline chloramphenicol and chloramphenicol palmitate is approximately 80%. The time for peak plasma concentrations is dependent on particle size and correlates with in vitro dissolution and deaggregation rates. The bioavailability of chloramphenicol after intravenous administration of the succinate ester averages approximately 70%, but the range is quite variable. Incomplete bioavailability is the result of renal excretion of unchanged chloramphenicol succinate prior to it being hydrolysed to active chloramphenicol. Plasma protein binding of chloramphenicol is approximately 60% in healthy adults. The drug is extensively distributed to many tissues and body fluids, including cerebrospinal fluid and breast milk, and it crosses the placenta. Reported mean values for the apparent volume of distribution range from 0.6 to 1.0 L/kg. Most of a chloramphenicol dose is metabolised by the liver to inactive products, the chief metabolite being a glucuronide conjugate; only 5 to 15% of chloramphenicol is excreted unchanged in the urine. The elimination half-life is approximately 4 hours. Inaccurate determinations of the pharmacokinetic parameters may result by incorrectly assuming rapid and complete hydrolysis of chloramphenicol succinate. The pharmacokinetics of chloramphenicol succinate have been described by a 2-compartment model. The reported values for the apparent volume of distribution range from 0.2 to 3.1 L/kg.(ABSTRACT TRUNCATED AT 400 WORDS)

Initial Evaluation for and Management of Bacteremia and Bacterial Meningitis in Infants

The diagnosis of bacteremia or meningitis in young infants may be straightforward or difficult. Clinical assessment is important in segregating a high risk group from the large number of febrile children with less serious infections. Specific diagnostic procedures such as culture of the blood and examination of the cerebrospinal fluid may need to be employed, despite a lack of definitive clinical or nonspecific laboratory test results. The physician who first encounters such children must develop guidelines for the use of these diagnostic tests.

Antagonism of ampicillin and chloramphenicol for meningeal isolates of group B streptococci.

The increasing prevalence of ampicillin-resistant Haemophilus influenzae type b has led to the recommendation that ampicillin and chloramphenicol be given as the initial therapy for suspected bacterial meningitis in infants and children. However, during the first 2 months of life, H. influenzae type b is a rare cause of meningitis, whereas group B streptococcus is the most frequently isolated agent. Since ampicillin and chloramphenicol have been shown to be antagonistic for other streptococci, an in vitro study of their effect on group B streptococci was performed. The effect of ampicillin and chloramphenicol, alone and in combination, on 18 meningeal isolates was determined for 2 different inocula of group B streptococci, using microtiter broth dilution and growth kinetic assays. Isoboles, fractional lethal concentration indices, or both indicated antagonism for all strains. Growth kinetic assays for two representative strains demonstrated inhibition of the early bactericidal activity of ampicillin by chloramphenicol. These findings of in vitro antagonism suggest that this combination may be contraindicated for the treatment of infants with group B streptococcal meningitis.

Antimicrobial Therapy of Bacterial Meningitis in Infants. Penetration of Antibiotics into Cerebrospinal Fluid

Antimicrobial Therapy of Bacterial Meningitis in Infants. Penetration of Antibiotics into Cerebrospinal Fluid

Mechanisms of brain damage in H. influenzae meningitis.

In recent years H. injluenzae has become the most common cause of bacterial meningitis in infants in the United States of America (1, 2). Although, over the last two decades, with steady improvement in methods of treatment (2, 3) the mortality rate has declined from over 90 per cent to about 10 to 15 per cent, the sequelae in the survivors may be serious. As many as 10 to 20 per cent may be left with some degree of neurological deficit. The cause of this is still uncertain. Alexander (4) has suggested that arteritis with thrombosis, and cerebritis, are the causes of neuronal damage, and others (5, 6) have emphasized the importance of subdural effusions. It is claimed that such effusions become enclosed by membranes which lead to restriction of brain growth at a time when the latter is still rapid. The present study of 34 fatal cases examined at the Cincinnati General and Children's Hospitals between 1932 and 1958 is mainly oriented to this problem of the mechanism or mechanisms by which H. injluenzae meningitis sometimes results in significant permanent brain damage. Although this form of meningitis was recognized at the end of the 19th century (7), and numerom; cases were diagnosed soon after World War I (8), only one paper is known to us (9) in which detailed attention is given to the pathological lesions. This was based upon an analysis of 14 fatal cases from the Boston City and Massachusetts General Hospitals. It contains much valuable information about the evolution of the inflammatory process in the meninges, associated vascular lesions, and brain damage, as well as clinico-pathological correlations. However, the time of its publication, in 1948, was before complicating subdural effusions had received adequate recognition and this factor was not considered.

The treatment of acute bacterial meningitis in infants and children.

For general practitioners, who handle more than 85 per cent of all pediatric care, Postgraduate Medicine here presents authoritative, up-to-date summaries by specialists in pediatric problems.

Subdural fluid complicating bacterial meningitis.

The purpose of this report is to draw attention to the frequent occurrence of a complication of bacterial meningitis that we believe may be a significant cause of residual brain damage if it is not recognized and treated early. A preliminary report 1 has already been published elsewhere. Subsequently Smith, Dormont, and Prather 2 reported a series of 20 patients with the same complication of meningitis, Meneghello and Aguilo 3 noted seven cases in Chile, and Arnold 4 recently described five similar cases. As early as 1916, A. B. Schwartz 5 specifically suggested meningitis as one cause of chronic subdural hematoma of infancy. Since that time a number of similar case reports 6 have appeared, but the high incidence of significant amounts of subdural fluid complicating bacterial meningitis in infants has not been generally recognized. This condition appears to be separate from secondarily infected subdural hemorrhage after head injury and