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Query: UMLS:C0085437 (bacterial meningitis)
 4,038 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To determine current opinions among experts in pediatric infectious diseases for treatment of bacterial sepsis, meningitis and acute otitis media, we polled directors of training programs in January, 1992. Responses were received from 69 centers in the United States and Canada. For initial treatment of presumed bacterial meningitis, the third generation cephalosporins alone or combined with ampicillin have become drugs of choice in all age groups. Most infectious disease programs include dexamethasone in the management of presumed bacterial meningitis for children 2 months of age and older. Third generation cephalosporins are also drugs of choice for presumed sepsis: combined with ampicillin for infants 5 weeks of age; used alone for children 5 months and 12 years of age. Amoxicillin remains the preferred drug for initial treatment of acute otitis media. The combination of amoxicillin and clavulanic acid is favored in the setting of an increased proportion of beta-lactamase-producing bacterial pathogens. Comparison of these results with polls in 1987 and 1989 indicates a shift in recommendations of therapy of presumed bacterial sepsis and meningitis from ampicillin alone or combined with an aminoglycoside or chloramphenicol to use of a third generation cephalosporin alone or combined with ampicillin.
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PMID:Therapy of bacterial sepsis, meningitis and otitis media in infants and children: 1992 poll of directors of programs in pediatric infectious diseases. 144 7

Sixteen temporal bones from eight children who had died of meningitis were histopathologically evaluated. Concurrent acute otitis media was demonstrated in 14 bones. In no case could a pathway of infection from the tympanomastoid compartment to the intracranial cavity be located. Further, inner ear infection appeared to be the result of retrograde bacterial invasion from the meninges rather than from an inoculation via the middle ear or mastoid. Should surgical drainage be required, the histopathologic findings indicate that mastoidectomy would have little advantage over myringotomy. We infer that a child with normal temporal bone anatomy is probably not at enhanced risk for development of bacterial meningitis from acute otitis media via a route of direct extension.
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PMID:Otologic features of bacterial meningitis of childhood. 397 77

Streptococcus pneumoniae continues to be the most common organism causing acute otitis media and sinusitis in infants and children and remains an important bacterial cause of pneumonia, septic arthritis, and bacterial meningitis in the pediatric age group. The definition, incidence, and mechanisms for penicillin resistance in pneumococcus are reviewed here. Physicians caring for children should know and understand these important concepts. At present, for most respiratory infections in children penicillin-resistant pneumococcus does not represent a clinical dilemma as far as regarding alteration of empiric antibiotic therapy. However, as this problem continues to grow, especially for patients with recurrent otitis media or sinusitis, physicians will be facing upper respiratory infections that are more commonly caused by these isolates and the antibiotic management of infections in the respiratory tract caused by penicillin and other antibiotic-resistant pneumococcal isolates will require modification.
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PMID:The emergence of resistant pneumococcus as a pathogen in childhood upper respiratory tract infections. 776 12

Twenty-four of 66 (363.6 +/- 116/1000) post-neonatal children with acute bacterial meningitis treated between August 1991 and November 1992 at the Emergency Paediatric Unit, University of Maiduguri Teaching Hospital, Nigeria, had co-existing localized extracranial infections (LEI). Nineteen had bronchopneumonia (of which 14 were in combination with other infections), two had dysentery and one each acute otitis media, orbital cellulitis, and purulent conjunctivitis. LEI were significantly more frequent in children < or = 2 years, and in children with delayed presentation and delayed diagnosis after presentation. Mortality rate was higher in children with LEI (500 +/- 200/1000) than in those without (102.6 +/- 95.2/1000) (P < 0.001). There was no significant relationship between the incidence of LEI and the causative organisms of meningitis or nutritional status of children with meningitis. We conclude that co-existing LEI are not infrequent in children with acute bacterial meningitis; they contribute to delayed diagnosis and are associated with a poorer outcome.
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PMID:Localized extracranial infections in children with acute bacterial meningitis. 793 37

We undertook a retrospective study to examine our experience with acute mastoiditis over a 12-year period. Fifty-eight cases were identified in children aged 3 months to 15 years. Acute mastoiditis was the first evidence of otitis media in 54% of our patients. Pain and fever lasting for more than a median period of 4 days were most likely to be the harbingers of incipient acute mastoiditis. Streptococcus pneumoniae was the most common organism recovered from the cultures. All children were treated with intravenous antibiotics; 41 children were managed with an adjunctive drainage procedure. No statistically significant differences were observed between the cure rates and failure rates for children treated surgically with myringotomies with or without tubes and children managed more aggressively with mastoidectomies. One infant had bacterial meningitis. Cholesteatoma was diagnosed in two children. We conclude from our study that acute mastoiditis occurs mainly in young children and may be the first evidence of ear disease. Pain and fever that persist despite appropriate treatment for acute otitis media are the two most important symptoms. Intravenous antibiotics combined with myringotomy with or without tube insertion are as appropriate as intravenous antibiotics with mastoidectomy for initial management of acute mastoiditis in the absence of a subperiosteal abscess or central nervous system extension.
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PMID:Acute mastoiditis in children: a 12-year retrospective study. 933 11

Increasing resistance to antimicrobial agents has occurred among many pathogens, but the emergence of resistant Streptococcus pneumoniae will have the greatest impact on the practice of outpatient medicine. Consequences of resistance include complicated management of acute otitis media and meningitis treatment failures. Pneumococci have acquired resistance to penicillin, third-generation cephalosporins and other antibiotics at an alarming rate; in some areas, 25 percent of isolates are nonsusceptible to penicillin. In areas with high resistance rates, the addition of vancomycin to cefotaxime or ceftriaxone is warranted for empiric treatment of bacterial meningitis. Changes in empiric therapy for pneumonia, bacteremia and otitis media may eventually be necessary. Previous antibiotic use is a risk factor for invasive disease with resistant pneumococci. Patients may be best protected by avoiding unnecessary use of antibiotics. Patient education materials as well as recommendations for avoiding the use of antibiotics for some upper respiratory tract infections are currently being developed to help physicians achieve this goal.
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PMID:Resistant pneumococci: protecting patients through judicious use of antibiotics. 937 Oct 6

Acute otitis media and otitis media with effusion (OME) have often been observed in children with bacterial meningitis. OME has also been proposed as the mechanism of reversible hearing loss after meningitis. In this controlled study, children with acute bacterial meningitis were studied using auditory brainstem responses (ABR), otoacoustic emissions, tympanometry and otoscopy. An age- and sex-matched control was recruited for each patient and the incidence of acute otitis media and OME was compared between the two groups. One hundred and twenty-four children with meningitis were studied. Ninety-two children (74 per cent) had meningococcal meningitis. Five patients (4 per cent) had conductive hearing loss (ABR threshold > or = 30 dB HL) at the time of discharge from hospital. None of the patients or controls had acute otitis media. Patients and controls were well matched for risk factors for OME and the prevalence of middle ear effusion in patients and controls was 7.2 per cent and 11.3 per cent respectively. The relative risk of OME in the children with meningitis was 0.64 (95 per cent confidence interval 0.29 to 1.42). After nine months, three of the five children with meningitis and conductive hearing loss had regained normal hearing. In contrast to previous reports, there was no relationship between bacterial meningitis and acute otitis media or OME in this study. Nevertheless, coincidental conductive hearing defects were identified as the cause of reversible hearing loss in three patients.
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PMID:Acute otitis media and otitis media with effusion in children with bacterial meningitis. 942 76

We performed a case study and intervention study, with follow-up of 1 to 5 years, in 4 children with inner ear malformations who underwent implantation of a multichannel cochlear implant (Nucleus, Cochlear Corporation) at ages 3 to 12 years. Malformations included a common cavity deformity, 2 incomplete partitions, and 1 case of isolated bilateral vestibular aqueduct enlargement. One child had a single-channel implant placed at 3 years of age, and this was exchanged for a 22-channel implant at age 9. One child had her implant placed at age 4.5 years, but due to complications from a cerebrospinal fluid (CSF) leak had the initial implant removed and replaced at age 5 years during repair of the CSF leak. Intraoperative findings included a CSF leak at the time of surgery in 3 patients. One patient contracted bacterial meningitis 7 months postimplantation that was thought to be secondary to acute otitis media in the unoperated ear. Bilateral CSF leaks were noted in the middle ear by a lumbar puncture radionuclide and fluorescein dye study. Successful repair of the CSF leaks and reimplantation of the cochlear implant was carried out in this patient. Mapping and programming of the implant was found to be challenging in each of these patients. All patients demonstrated improved performance after implantation. Two patients demonstrated some open-set speech perception. One patient demonstrates improved use of temporal cues in a structured closed set. One patient has achieved no significant speech recognition at this time, but does have improved sound detection and awareness. Cochlear implantation in children with congenital inner ear abnormalities can be a successful method of rehabilitation. It should be recognized that the postoperative speech perception results may be highly variable among patients, and that intraoperative complications may occur.
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PMID:Cochlear implantation in children with inner ear malformations. 963 59

Antibiotic-resistant strains of Streptococcus pneumoniae are becoming more prevalent throughout the world; this has resulted in modifications of treatment approaches. Management of bacterial meningitis has the greatest consensus. Strategies for treating other systemic infections such as pneumonia, bacteremia, and musculoskeletal infections are evolving, in part related to the availability of new antibiotics which are active in vitro against isolates resistant to penicillin and the extended-spectrum cephalosporins. However, there are currently very limited data related to the clinical efficacy of these new agents. The studies upon which current recommendations are based are reviewed. Otitis media represents the single most common infection due to S. pneumoniae. Recommendations for treatment of acute otitis media due to drug-resistant strains and the rationale for these recommendations are discussed.
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PMID:Management of infections due to antibiotic-resistant Streptococcus pneumoniae. 976 60

Twenty-two children with bacterial meningitis were prospectively studied to follow C-reactive protein (CRP) in serum at admission, 2nd, 5th and 7th days of treatment, and in the cerebrospinal fluid (CSF) at admission, to investigate if there is any relationship of its levels with the clinical evolution. CRP was measured by latex agglutination and/or ELISA techniques with detection limits of 0.15mg/L and 0.9mg/L, respectively. Patients were classified according to clinical evolution in two groups: uneventful recovery (n=12) and complicated evolution (n=10). Clinical complications observed were: relapse of fever (8), persistent fever (4), arthritis (4), ventricle enlargement (2), subdural effusion (1), subdural empyema (1), ataxia (1), cervical hypotonia (1), deafness (1), endophthalmitis (1), acute otitis media (1), secondary skin infection (1) and treatment change due to poor clinical response (1). A significant fall in CRP serum levels was observed among the uneventful recovery group after admission. Distinctly, in the group with a complicated evolution CRP levels showed either secondary elevation or remained high continuously. Mean serum CRP levels were significantly lower in the uneventful recovery group than in the complicated evolution group on 5th day and on 7th day. CRP levels below 20mg/L on 5th and 7th days were associated with an uneventful recovery, and CRP levels higher than 20mg/L on those same days were associated with a complicated clinical evolution (p=0.01* and p=0.0015*, respectively). We conclude that serum CRP levels monitoring in children with bacterial meningitis represents a useful and objective information about the clinical evolution. This procedure is inexpensive and suitable for use in endemic areas lacking sophisticated laboratories.
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PMID:C-reactive Protein Follow-up of Children With Acute Bacterial Meningitis. 1109 88


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