Meningitis In Pediatric Patients Research Articles

Viral Meningitis (Enterovirus) Outbreak in The Pediatric Population of Sulaymaniyah Governorate, Iraq: A Multi-Center Experience

Introduction Viral meningitis, often caused by enteroviruses in children, is prevalent globally but is difficult to distinguish from bacterial forms. Molecular testing like PCR is vital; however. This study investigates the characteristics of viral meningitis in pediatric patients during an outbreak in Sulaymaniyah Governorate, Iraq. Methods This is a multicentered prospective study that included children with a confirmed diagnosis of viral meningitis who have visited pediatric clinics throughout Sulaimani, Halabja, Kalar, and Ranya cities during the period from May 2023 to June 2023. Results In total, 116 cases were included, of whom 75 (64.7%) were male and had a mean age of 6.5 ± 3.2. Most were between the ages of 4-6 (38, 32.8%) and 7-12 years (55, 47.4%). Only 53.4% had contact with another patient. Common symptoms included fever (63.8%) and headache (62.1%). Lymphocyte predominance was observed in 46.6% of CSF samples. Upon molecular diagnosis, the inflammation in all of the cases was due to enterovirus infection. Most of the patients (75%) received empirical antibiotics. The average hospital stay was 10 days. While 95.7% of patients had no complications during recovery, a few experienced issues like weakness and malaise. All had good clinical outcomes. Conclusion The viral meningitis outbreak in Sulaymaniyah Governorate is caused by enterovirus, with epidemiological, clinical, and laboratory findings similar to that of the literature. The condition has resulted in a high prescription rate of empirical antibiotics due to late diagnosis.

Audit of adherence to international guidelines (IDSA) in the treatment of infectious meningitis in pediatric patients in Jordan

Objective This study aims to audit the adherence of Jordanian medical care staff to the guidelines provided by the Infectious Disease Society of America (IDSA) for managing pediatric patients admitted with suspected cases of meningitis. Methods A retrospective observational study was conducted at Jordan University Hospital (JUH). All pediatric patients admitted to JUH with suspected meningitis between January 1, 2019, and September 30, 2022, who underwent Cerebrospinal Fluid (CSF) and blood culture tests were recruited in this study unless there was a reason for exclusion. The study collected data on the empiric antibiotics prescribed prior to diagnostic cultures and susceptibility results. Additionally, the length of hospital stay and all-cause mortality were observed. The appropriateness of antibiotics prescription before culture results was compared to IDSA guidelines, and an overall adherence rate was calculated. Results A total of 332 pediatric patients were included in this study, of whom 12.3% (n = 41) were diagnosed with bacterial meningitis. Among the enrolled pediatric patients, only 27 patients (8.1%) received appropriate treatment adhering to the IDSA guidelines. The remaining 91.9% (n = 305) showed various forms of non-adherence to recommendations. The highest adherence rate was observed for performing CSF culture (n = 330, 99.4%), while the lowest adherence rate was found in selecting the appropriate dose and duration for empiric antibiotics (n = 107, 41.3% and n = 133, 51.0%, respectively). Conclusion This study revealed a low overall adherence in the management of pediatric patients with meningitis in Jordan. Establishing an antimicrobial stewardship program may improve the outcomes of meningitis infections found in Jordan, and prevent dangerous adverse effects and bacterial resistance.

Cerebrospinal Pharmacokinetic Analysis and Pharmacodynamic Evaluation of Ceftriaxone in Pediatric Patients with Bacterial Meningitis

What Is Known? and Objective. Ceftriaxone has been widely used to treat bacterial meningitis in pediatric patients. Ceftriaxone dosing regimens of 80–120 mg/kg/day have been recommended for bacterial meningitis in pediatric patients, and the usual duration of therapy is 7–14 days. Although the target site for meningitis is cerebrospinal fluid (CSF), a CSF pharmacokinetic (PK) model in pediatric patients has not been reported. We aimed to develop a CSF PK model of ceftriaxone, using not only serum but also CSF concentration data, and to evaluate the appropriateness of dosing regimens for pediatric patients with bacterial meningitis. Methods. The population PK model was developed by simultaneously fitting serum and CSF data from pediatric patients described in nine published articles. Probabilities of attaining a pharmacodynamic target (100% T > MIC, 100% of time that drug concentrations above the minimum inhibitory concentration) in CSF were estimated for some dosing regimens. Results and Discussion. Twenty-four pediatric patients with meningitis were the subjects for PK modeling (0.52–13 years old, and 3.5–50 kg of body weight). Sixty-eight serum concentrations and 98 CSF samples were used to develop the CSF PK model. The CSF/serum concentration ratio at the same sampling time was 0.0628 ± 0.0689. Age was not a statistically significant covariate in the PK parameter. In the CSF PK model, 40–60 mg/kg q12 h achieved a target attainment probability >90% against causative bacteria for bacterial meningitis. However, 4-h infusion (rather than 0.5-h infusion) dosing regimens were required for efficacy against antimicrobial-resistant bacteria with high MICs. What Is New? and Conclusion. Ceftriaxone-dosing regimens with prolonged infusion times might be reasonably effective for treating antimicrobial-resistant pathogens in empiric therapy.

Clinical outcomes and risk factors of Acinetobacter baumannii meningitis in pediatric patients at a tertiary hospital in China.

To summarize the clinical characteristics, outcomes and identify risk factors of Acinetobacter baumannii (AB) meningitis in children. This was a single-center, retrospective study. Children hospitalized between January 2016 and December 2021 who were diagnosed with AB meningitis were included. The clinical characteristics and outcomes were reviewed. Risk factors were determined using univariate analyses (chi-square and Mann-Whitney U tests). Seventeen patients were included; 15 cases were secondary to neurosurgery, and two were neonates with primary bacterial meningitis. Common symptoms included fever, convulsions and nervous system abnormalities. Cerebrospinal fluid (CSF) tests typically showed increased white blood cell counts dominated by neutrophils, reduced glucose levels and elevated protein levels. Ten patients were successfully treated (successful treatment [ST] group); seven had failed treatment (failed treatment [FT] group). Univariate analyses revealed that mechanical ventilation, routine white cell counts in the peripheral blood, procalcitonin, protein in the CSF, septic shock and carbapenem-resistant AB (CRAB) differed significantly between the groups. AB meningitis in children has a high mortality rate. FT was associated with mechanical ventilation, septic shock, CRAB, lower peripheral leukocyte counts, higher protein levels in the CSF and procalcitonin. Larger studies are needed to identify independent risk factors for adverse outcomes.

Predictive value of inflammatory factors on the efficacy of adjuvant Dexamethasone in the treatment of refractory purulent meningitis among pediatric patients.

The aim of this study was to figure out the predictive value of inflammatory factors on the efficacy of Dexamethasone adjuvant therapy for refractory purulent meningitis in children. In, this study, a regression analysis method was employed to select a sample of 38 children with refractory purulent meningitis, 40 children with purulent meningitis, and 40 healthy children who visited to Ganzhou People's Hospital for physical These participants were then assigned to the Dexamethasone, standard care and the control groups. The inflammatory factors in the three groups were compared, and a multivariate Logisitic regression was analysis was conducted to examine the predictive indicators and efficacy of Dexamethasone treatment in children with refractory purulent meningitis. The levels of CRP, TNF-a, IL-6, PCT and IL-1 were found to be significantly higher in the Dexamethasone group to both the standard care and the control (P < 0.05). Through multivariate Logisitic regression analysis, it was determined that CRP, TNF-a, IL-6, PCT, and IL-1 were reliable predictors of the efficacy of Dexamethasone treatment in children with refractory purulent meningitis. These biomarkers demonstrated good predictive performance, with CRP and IL-1 showing superior predictive performance. Inflammatory factors have a certain predictive value for the efficacy of Dexamethasone adjuvant therapy for refractory purulent meningitis in pediatric patients.

Validation of a Clinical Prediction Rule for Distinguishing Bacterial and Aseptic Meningitis in Pediatric Patients.

Introduction The treatments and prognosis of bacterial meningitis differ greatly from those of aseptic meningitis, making early identification and differentiation essential. Several different clinical prediction rules have been developed to distinguish bacterial meningitis from aseptic meningitis. We sought to validate one clinical prediction rule for pediatric patients utilizing a centralized data warehouse that collects daily data from 184 hospitals across the United States. Methods We retrospectively collected data on all patients aged 29 days to 14 years who presented to Hospital Corporation of America (HCA) Healthcare hospitals from January 1, 2016, to May 31, 2021, with a diagnosis of meningitis. Our study replicated the original study of the meningitis score for emergencies (MSE) for the pediatric clinical prediction rule and assigned 3 points for procalcitonin (PCT) >1.2 ng/dL, 2 points for CSFprotein >80 mg/dL, and 1 point for each of the other variables of C-reactive protein (CRP) >40 mg/L and CSF absolute neutrophil count >1000 cells per mm3. Patients were categorized either as having bacterial or aseptic meningitis. Using the clinical prediction rule, a calculation of the sensitivity, specificity, positive predictive value, negative predictive value, and receiver operating characteristic (ROC) curve was performed. Results The optimum test characteristic was found to have a score of ≥ 3, showing a sensitivity of 92.86% (95% CI, 83.3-100), a specificity of 65.22% (95% CI, 51.5-79), a positive predictive value of 61.90% (95% CI, 47.2-76.6), and a negative predictive value of 93.75% (95% CI, 85.4-100). The ROC curve from this study showed an area under the curve (AUC) of 0.7892 (95% CI, 0.681-0.897). Conclusion Our study validated a high sensitivity for distinguishing bacterial meningitis from aseptic meningitis, suggesting the clinical prediction rule has clinical utility as a predictive screening tool. Although the original MSE advised a cutoff score of ≥1, our study suggests that a score ≥3 would give the best test performance.

Predictors of catheter-associated meningitis in pediatric patients after brain tumor surgery: A 10-year single center experience

ObjectiveTo evaluate the incidence of catheter-associated meningitis (CAM) in a pediatric population receiving brain tumor surgery, and to identify the major risk factors involved. MethodsWe retrospectively analyzed the medical and radiological records of 205 pediatric patients who received 251 external ventricular drains (EVDs) between January 2008 and December 2017. All patients less than 18 years old who underwent cerebrospinal fluid (CSF) diversion in the course of brain tumor surgery were included. Patients with central nervous system infection (CNS) at the time of EVD insertion were excluded. ResultsA total of 99 patients receiving 107 EVDs met the study selection criteria. Among this population, the incidence of CAM was 19.2%. Median time-to-infection was 5 days. CAM prolonged the period of drainage in 57.9% of the cases. An extended ICU stay (>3 days) was statistically significantly associated with the occurrence of CAM. In the multivariate analysis, the presence of a high-grade CNS tumor was a predictor of an extended intensive care unit (ICU) stay. Furthermore, CSF leakage along the catheter tunnel was an independent predictor of CAM. ConclusionOur data confirms CAM as a significant complication in the acute treatment of hydrocephalus associated with pediatric brain tumors. To limit the incidence of CAM, measures must be taken to prevent CSF leakage, particularly among patients with high-grade CNS tumors that are likely to stay longer in the ICU and need prompt postoperative radiotherapy and oncological treatment.

The Application of Bacterial Meningitis Score for Bacterial Meningitis and Enteroviral Meningitis in Pediatric Patients

The Application of Bacterial Meningitis Score for Bacterial Meningitis and Enteroviral Meningitis in Pediatric Patients

Bacterial meningitis in pediatric patient with C2 deficiency

Bacterial meningitis in pediatric patient with C2 deficiency

Response of Vancomycin according to Steroid Dosage in Pediatric Patients with Culture-Proven Bacterial Meningitis.

BackgroundThis study aimed to evaluate the efficacy of combined vancomycin and steroid therapy for the treatment of culture-proven bacterial meningitis in pediatric patients.Materials and MethodsWe identified a total of 86 pediatric patients with culture-positive cerebrospinal fluid who were treated at our facility between 2005 and 2015. Ten of these patients (5 boys and 5 girls) received first-line treatment with vancomycin as the initial form of therapy. All cultured bacteria were sensitive to vancomycin. We retrospectively analyzed these cases to examine the relationship between concomitant steroid dosage and antibiotic treatment effectiveness.ResultsNine of the 10 patients included in our analysis received steroid treatment. Of these, 3 received high-dose steroid therapy and 6 received low-dose steroid therapy. Five patients did not respond to vancomycin, including all 3 patients in the high-dose steroid group and 2 patients in the low-dose steroid group. Our analysis confirmed that the response rate to vancomycin treatment was significantly reduced in accordance with steroid dosage (P = 0.035). Patients who did not to respond to vancomycin with concomitant high-dose steroid administration improved clinically after the substitution of vancomycin with teicoplanin.ConclusionThe use of steroids, especially in high doses, may impair the effectiveness of vancomycin for treating bacterial meningitis in pediatric patients. Physicians should be cautious when administering concomitant steroid therapy and should carefully monitor the steroid dosage.

Widespread circulation of echovirus 6 causing aseptic meningitis in paediatric patients in the area of Modena, Italy, in 2011

&lt;p&gt;&lt;em&gt;Introduction&lt;/em&gt;: Between May and November 2011, enterovirus RNA was detected in the cerebrospinal fluids (CSFs) of 72 children with signs of aseptic meningitis admitted to paediatric departments of different Hospitals of the prefecture of Modena, Emilia Romagna region, Italy. Enterovirus RNA was detected in 34 CSFs by commercial reverse transcriptase-polymerase chain reaction (RT-PCR). Twenty-one samples, resulted human enterovirus B by species-specific RT-nested PCR, were submitted to sequencing of the 3’ terminus of the VP1 gene. &lt;br /&gt;&lt;em&gt;Materials and Methods:&lt;/em&gt; Upon sequencing and interrogation of the National Center for Biotechnology Information database, all 21 viruses were characterized as echovirus 6 (E6), and posses a 100% nucleotide identity each other.&lt;br /&gt;&lt;em&gt;Results&lt;/em&gt;: This study reports the molecular detection and typing of E6 isolated from clinical specimens from paediatric patients with aseptic meningitis in the wide area of Modena, Italy, in 2011.&lt;/p&gt;

Epidemiologic, clinical and bacteriologic characteristics of pneumococcal meningitis in pediatric patients from Lima, Peru

To describe the clinical characteristics, lethality, antibiotic susceptibility, and serotype distribution of pneumococcal meningitis in pediatric patients in Lima, Peru. A case series of pneumococcal meningitis in children less than 16 years of age from two prospective, multicenter, passive surveillance studies of invasive pneumococcal diseases held in Lima-Peru from 2006 to 2008 and 2009 to 2011. We report 44 pneumococcal meningitis episodes; 68.2% of them were in children less than 2 years old. The overall case fatality rate was 32.6%; 92.9% of fatal cases were in children less than 2 years of age (p<0.05). Malnutrition was associated with fatal cases (p<0.05). 64.3% of fatal cases died within the first two days. 41.9% of pneumococcal isolates were resistant to penicillin, 23.3% were intermediate resistant to ceftriaxone (none were highly resistant) and 9.3% were resistant to chloramphenicol. The most common serotypes were 6B, 14, 19F and 23F, which accounted for 68.3% of all strains; 84.1% of strains were PCV13 serotypes. Pneumococcal meningitis continues to be a lethal disease, especially in children less than 2 years of age. Since almost two third of lethal cases lead to death within the first 48 hours, prompt diagnosis and management is critical, as well as assurance of immunization with pneumococcal vaccine.

Pattern of cerebrospinal fluid analysis in children above the neonatal age as seen at the University of Port Harcourt Teaching Hospital

Background: Bacterial meningitis is a potent cause of morbidity and mortality in the paediatric age group. The aim of this study was to review the results of analysis the cerebrospinal fluid (CSF) collected from children above the neonatal age who were suspected to be having meningitis and to also determine the susceptibility pattern of these isolates. Methods: A descriptive retrospective study of results of CSF culture reports taken from paediatric patients aged 1 month to 16 years with clinical suspicion of bacterial meningitis at the University of Port Harcourt Teaching Hospital between January 1, 2009, and December 31, 2014. The CSF samples were subjected to macroscopic examination, white blood cell count, Gram's stain and culture. Organisms isolated were characterised by standard procedure and antibiotic susceptibility testing was done according to the Clinical Laboratories Standard Institute guidelines. Data were retrieved from laboratory record books and analysed using Microsoft Excel sheet. Results are presented as tables and pie chart. Results: Five hundred and seventy-four samples were received from children who were above the neonatal age (28 days). Of these, 329 were male (57.3%), 240 were female (41.8%), while in 5 (0.9%) of the samples, the sex was not indicated. Only 10 (1.7%) samples were positive for culture. Of these, Gram-positive cocci were the most common organisms, of which Staphylococcus aureus was the most prevalent, being 7 (70%), followed by Escherichia coli (20%), while the least prevalent organism was β-haemolytic streptococci (10%). The organisms all exhibited resistance to amoxicillin-clavulanic acid. Ceftazidime exhibited 100% sensitivity against E. coli isolates. Ceftriaxone, cefotaxime and ciprofloxacin exhibited good sensitivity among all the bacteria isolates that were cultured. Conclusions: There was a low yield of bacteria in CSF culture of paediatric patients at the University of Port Harcourt. The third-generation cephalosporins are still effective in bacterial meningitis in paediatric patients.

Current Approach to Meningitis in Pediatric Patients

In children bacterial meningitis is less frequently seen after introduction of pneumococcal, and most recently meningococcal conjugated vaccines into clinical practice. Menengitis is defined as the infection of the meninges around the brain. The specificity of the symptoms and signs of menengitis is decreased in infants. In infants subtle symptoms like fever, agitation, poor breast feeding and disorientation can be observed. New diagnostic methods based on available symptoms and signs like “Bacterial Menengitis Scoring” system was developed to predict the probability of bacterial menengitis. in stable patients. With suspect menengitis lumbar punction and appropriate blood tests should be performed. Complete blood count, peripheral blood glucose, leucocyte,erythrocyte, glucose, protein in CSF, should be determined and gram stain should be evaluated at a first step. Treatment of bacterial meningitis should be initiated without delat with broad spectrum antibiotherapy based on antibiotic susceptibility in the community. Studies focus on decreased mortality with the early antimicrobial therapy.At present meningitis is still a major cause of mortality and morbidity in pediatric age group, and infants, and adolescents constitute the most risky groups.

Antibiotic therapy in pyogenic meningitis in paediatric patients.

To isolate and identify the causative pathogen, antibiotic sensitivity testing and success rate of empirical antibiotic therapy in pyogenic meningitis. Analytical study. The Children's Hospital and Institute of Child Health, Lahore, Pakistan, from March to July 2012. The study was performed on 72 culture positive meningitis cases in children less than 15 years of age. This therapy was evaluated by monitoring the patient's clinical picture for 14 - 21 days. The collected data was analyzed by Chi-square test. Seventeen different bacteria were isolated. The most commonly occurring bacteria were coagulase negative Staphylococci (25%), E. coli (12.5%), Klebsiella pneumoniae (8.3%), Streptococcus pneumoniae (8.3%) and Pseudomonas aeruginosa (8.3%). All the bacteria were sensitive to vancomycin (96.7%), meropenem (76.7%), amikacin (75%), ciprofloxacin (65.3%), chloramphenicol (46.5%), ceftazidime (44.2%), cefepime (41.9%), co-amoxiclav (38.0%), oxacillin (34.8%), cefotaxime (21.4%), penicillin (20.7%), ceftriaxone (18.6%), cefuroxime (14%) and ampicillin (6.9%). The combination of sulbactam and cefoperazone showed antimicrobial sensitivity of 81.4%. The success rate of empirical antibiotic therapy was 91.7%. It was found that Gram negative bacteria were the major cause of pyogenic meningitis. Mostly there were resistant strains against all commonly used antibiotics except vancomycin. All empirical antibiotic therapies were found to be most successful.

Cerebrospinal fluid Adenosine deaminase: its evaluation as a marker for diagnosing tuberculous meningitis in paediatric patients.

Five hundred thousand patients of tuberculosis die every year in India. Delay in diagnosis and in initiating treatment results in poor prognosis. This disease is affecting the children more and more. Meningeal tuberculosis has acquired an endemic shape with about 12% incidence. The aim of the present study is to evaluate Cerebrospinal fluid Adenosine deaminase: as a marker for diagnosing tuberculous meningitis Eighty paediatric patients of age group 6-24 months having symptoms and signs of meningitis were divided into two groups; tuberculous and non-tuberculous, as per the accepted criteria. The CSF was drawn and ADA levels estimated in all patients. Out of 38 tuberculous patients, 36 had CSF ADA at or above the cutoff value, while 02 had below. Out of 42 non-tuberculous patients, 04 patients had at or above while 38 were below the cutoff value. Results of our study indicate that ADA levels in CSF are not only of considerable value in the diagnosis of TBM; CSF ADA level 10 IU/L as a cutoff value exhibited 94.73% sensitivity;90.47% specificity; 90.00% positive predictive value and 95.00% negative predictive value. Cerebrospinal fluid Adenosine deaminase estimation is less expensive, rapid and fairly specific method for the diagnosis of tuberculous etiology in TBM; it may prove to be diagnostic marker for diagnosing tuberculous meningitis in paediatric patients. KeyWords: Adenosine deaminase (ADA), Cell-mediated immunity (CMI), Cerebrospinal fluid (CSF), Tuberculous meningitis (TBM),

Effectiveness of the association of dexamethasone with antibiotic therapy in pediatric patients with bacterial meningitis

To evaluate the efficacy of the association of corticosteroids and the standard treatment of bacterial meningitis in pediatric patients. A systematic review of the literature was conducted through the MEDLINE database. Only randomized controlled trials comparing dexamethasone with placebo in the treatment of pediatric patients with bacterial meningitis were included. Eight articles met the inclusion criteria and were selected for analysis. There were no difference in mortality (p = 0.86), and incidence of neurological (p = 0.41) and auditory (p = 0.48) sequelae between the groups. There are no benefits in associating corticosteroids with the standard treatment of bacterial meningitis in pediatric patients.

Eficácia da associação de dexametasona à antibioticoterapia em pacientes pediátricos com meningite bacteriana

OBJETIVO: Avaliar a eficacia da associacao de corticoide ao tratamento padrao da meningite bacteriana em pacientes pediatricos. METODOS: Realizou-se revisao sistematica da literatura atraves da base de dados MEDLINE. Foram incluidos apenas ensaios clinicos controlados e randomizados que comparassem a dexametasona ao placebo no tratamento de pacientes pediatricos com meningite bacteriana. RESULTADOS: Oito artigos preencheram os criterios de inclusao e foram selecionados para analise. Nao houve diferenca nas taxas de mortalidade (p = 0,86) ou de incidencias de sequelas neurologicas (p = 0,41) e audiologicas (p = 0,48) entre os grupos. CONCLUSAO: Nao existem beneficios na associacao de corticoide ao tratamento da meningite bacteriana em pacientes pediatricos.

Recurrent Streptococcus pneumoniae meningitis in a child with traumatic anterior cranial base defect

Acute bacterial meningitis is a potentially life-threatening infection of the cranial and spinal leptomeninges. Recurrent episodes of meningitis are rarely seen, but when they occur, an extensive investigation has to be made to find out responsible factors. A single episode of acute meningitis may result from bacteriemia, but when followed by recurrent meningitis in pediatric patients, other possible routes of the bacteria invasion to the cerebrospinal fluid (CSF) should be considered. Patients with head injury have the highest risk of acquiring recurrent bacterial meningitis, followed by patients with a congenital anatomic lesion of the skull or duramater, such as meningomyelocele. The underlying cause is a transdural communication between the meningeal space and paranasal sinuses or skin. The first attack of meningitis may occur several weeks to 12 years after the head injury. In addition, recurrent bacterial meningitis may be due to disorders of the immune system, such as complement deficiency. We report a 14-year-old boy, who suffered from recurrent Streptococcus pneumoniae meningitis due to a well-defined defect at the ethmoid roof after a head trauma.

Pharmacodynamic Evaluation of Meropenem and Cefotaxime for Pediatric Meningitis

To determine the probability of meropenem (Merrem, AstraZeneca Pharmaceuticals L.P., Wilmington, DE, USA) and cefotaxime (Claforan, Aventis Pharmaceuticals Inc., Bridgewater, NJ, USA) achieving bactericidal exposures in the cerebrospinal fluid against Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. A 5,000-patient Monte Carlo simulation in a population of 10-year-old children with meningitis was conducted. Pediatric pharmacokinetic data were derived from the literature. Pathogen minimum inhibitory concentrations (MICs) were obtained from common bacteria that had caused meningitis collected during pediatric clinical trials. Time above the MIC exposures in the cerebrospinal fluid was calculated. Bactericidal exposure or probability of target attainment was defined as 40% and 50% time above the MIC for meropenem and cefotaxime, respectively. High cumulative fractions of responses were defined as >90% probability of target attainment against the populations of bacteria. Meropenem was calculated to achieve 94.7%, 94.3%, and 96.1% cumulative fractions of response against S. pneumoniae, H. influenzae, and N. meningitidis, respectively. Cefotaxime only achieved a high likelihood of bactericidal attainment against N. meningitidis (91.6%). Against S. pneumoniae and H. influenzae, cefotaxime was only calculated to achieve 84.3% and 84.8% cumulative fractions of response, respectively. In a simulated population of 10-year-old children, meropenem had a high likelihood of attaining bactericidal exposures in the cerebrospinal fluid. Cefotaxime had a >90% cumulative fraction of response against only N. meningitidis. Therefore, at the doses simulated, meropenem may be a more appropriate empiric choice for the treatment of bacterial meningitis in pediatric patients presumed to be caused by these pathogens until culture and susceptibility data are available.