Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0085437 (bacterial meningitis)
 4,038 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Third-generation cephalosporins are important additions to the range of antibiotics available for treating children with serious bacterial infections. They are highly active against the common pathogens, which cause bacterial meningitis in children. Strains of Haemophilus influenzae type b resistant to both ampicillin and chloramphenicol, and Streptococcus pneumoniae relatively resistant to penicillin remain susceptible to cefotaxime and ceftriaxone. Escherichia coli, Klebsiella pneumoniae, Citrobacter diversus, as well as the other more common gram-negative bacilli isolated from neonates and children are susceptible to these agents. However, Listeria monocytogenes is not cephalosporin-sensitive. Ceftazidime is the only third-generation cephalosporin useful for treating serious infections due to Pseudomonas aeruginosa in children. As with other beta-lactam antibiotics, the clearance of cephalosporins is prolonged in neonates, particularly premature babies. Cefotaxime and ceftriaxone are equivalent to ampicillin and chloramphenicol for the treatment of bacterial meningitis in children over two to three months of age with respect to neurologic outcome and safety, despite the in vitro activity of cefotaxime and ceftriaxone being much greater than the standard antibiotics for the meningeal pathogens. Cefotaxime and ceftriaxone are effective in the treatment of serious gram-negative infections in children. In many instances, ceftriaxone can be administered once daily, which allows for more convenient therapy, particularly on an outpatient basis. Although controversial, ceftazidime has been used as single-agent therapy for empiric treatment of neutropenic immunocompromised children with fever.
 ...
PMID:Serious pediatric infections. 218 5

Haemophilus influenzae is a gram-negative rod, causing severe infections in childhood, including meningitis, sepsis, epiglottits, pneumonia and otitis. Most of the invasive infections are due to serotype b. Since ampicillin-resistance is increasing, modern cephalosporines like cefotaxime and ceftriaxone are the antibiotics of choice in severe disease. Bacterial meningitis due to Haemophilus influenzae and epiglottitis are both still life-threatening diseases with a lethality of 5% to 25%, and there are severe sequelae in 35% of meningitis cases. Efforts have been made to develop efficacious vaccines. While immunogenicity of type b polysaccharide was low in the high-risk age (below 18 months), conjugated vaccines with either diphtheria-toxoid or Neisseria meningitis outer membrane protein and the Hib polysaccharide were found to be strongly immunogenic even in the first months of life. These vaccines show every few side-effects and can easily be combined with other immunizations such as DPT and DT. Thus, the incidence of invasive infections due to Haemophilus influenzae type b might decline in future.
 ...
PMID:[Haemophilus influenzae type B. Disease and prevention]. 219 58

A high index of suspicion of meningitis is needed when evaluating neonates and young infants because clinical findings can be minimal and are often subtle and nonspecific. Analysis of the CSF constitutes the most effective method to document meningeal bacterial infection, although overlap with normal CSF values can occur, especially in newborns and very young infants. The introduction of highly active third-generation cephalosporins (ceftriaxone, cefotaxime) and their safety and efficacy in treating a broad array of bacterial pathogens that cause meningitis in all age groups has simplified selection of initial antibiotic therapy. In neonates, however, conventional antibiotic therapy with ampicillin and an aminoglycoside is appropriate because of its proven record of safety and efficacy, and because routine use of cephalosporins in the hospital nursery could lead to selection of resistant strains among gram-negative enteric bacilli. Despite the availability of modern intensive care management of infants and children with bacterial meningitis and the advent of potent antibiotics, case fatality rates and morbidity remain high. Because of this, recent research has focused on the complex interaction between bacteria and the host and on means to attenuate the meningeal inflammatory response. The clinical benefits demonstrated recently with the use of dexamethasone therapy in infants and children with bacterial meningitis underscore the importance of anti-inflammatory therapy to reduce audiologic and neurologic sequelae. Future studies of new methods to modulate meningeal inflammation such as the use of monoclonal antibodies directed against cytokines or of agents that interfere with leukocyte-endothelial interactions are indicated. The implication of routine H. influenzae type b immunization in young infants with the conjugated vaccines and optimal intrapartum prophylaxis against group B streptococcal disease in newborns will have an important impact on the incidence of meningitis in infants and children.
 ...
PMID:Bacterial meningitis in neonates and children. 227 92

Bacterial meningitis continues to be an important cause of morbidity and mortality despite the availability of effective bactericidal antibiotics. Penicillin or ampicillin remains the drug of choice for meningitis caused by Streptococcus pneumoniae and Neisseria meningitidis. The third generation cephalosporins have revolutionized the treatment of gram-negative meningitis. Future therapy for bacterial meningitis will use recent developments in the understanding of pathogenic and pathophysiologic mechanisms underlying this disease.
 ...
PMID:Bacterial meningitis in adults. 227 93

A case of mixed bacterial meningitis with Haemophilus influenzae and Streptococcus pneumoniae is reported in a 26-year-old woman without demonstrable predisposing conditions, who recovered after treatment with ampicillin, without sequelae.
 ...
PMID:Mixed bacterial meningitis in an adult caused by Haemophilus influenzae and Streptococcus pneumoniae. A case report. 230 46

A 3 year old girl was admitted with suspected bacterial meningitis. The patient's history concerning renal and cerebral function and known allergies had been uneventful until that time. 36 h after initiation of a high dose antibiotic therapy with Penicillin G (0.5 Mega IE/kg/day) and Amoxicillin (400 mg/kg/day) macrohematuria and consecutive anuria was observed. Prerenal cardiocirculatory failure, a Schwartz-Bartter-reaction as well as coagulatory failure could be ruled out. There were no symptoms of hypersensitivity. Sonographic examinations of the kidneys and the urinary tract as well as urinanalysis suggested an acute tubular obstruction and papillary necrosis caused by amoxicillin. After changing the antibiotic regimen to chloramphenicol and induction of diuresis by furosemide and dopamine renal failure could be resolved within 39 h. The patient recovered completely. High dose therapy with amoxicillin (greater than 300 mg/kg/day) includes the risk of tubular obstruction due to cristalluria. Solubility of ampicillin in aqueous fluids (6.5 mg/ml at pH 7) should be supported by sufficient diuresis and urine alkalization.
 ...
PMID:[Acute renal failure with high-dose combination therapy with penicillin G and amoxicillin]. 232 16

Three infants having Listeria monocytogenes meningitis were admitted to our hospital in the last ten years. They were a nineteen-month-old boy, a two-year-old girl and a five-year-old girl. They were all healthy infants. The two female patients survived, while the male patient died. At autopsy, arachnoid turbid, swollen brain substance and slight bleeding under the cerebellar tent were observed. Judging from the minimal inhibitory concentration of antibiotics against the isolated L. monocytogenes, antibacterial activity of penicillin G and ampicillin was good, whereas that of cefotaxime and latamoxef was poor. In conclusion, for therapy of bacterial meningitis due to unknown origin, the combination of ampicillin and cephalosporins is necessary.
 ...
PMID:[Three cases of meningitis due to Listeria monocytogenes type Ib]. 233 9

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.
 ...
PMID:Sequelae of acute bacterial meningitis in children treated for seven days. 242 33

In a multicentre study, 220 consecutive cases of bacterial meningitis in children older than 3 months were randomised to treatment with chloramphenicol, ampicillin (initially with chloramphenicol), cefotaxime, or ceftriaxone. The drugs were given in four equal daily doses for 7 days, except ceftriaxone which was given only once daily. 200 cases could be assessed; the causative organisms were Haemophilus influenzae type b (Hib) in 146; meningococci (Mnc) in 32; pneumococci (Pnc) in 13; and other or unknown in 9. In patients with Hib meningitis, sterilisation of the cerebrospinal fluid occurred most rapidly with ceftriaxone. Otherwise, in terms of overall clinical recovery, normalisation of laboratory indices, clinically significant adverse reactions, toxic effects, sequelae, and mortality rate, the treatment groups were very similar. However, there were 4 bacteriological failures, all in the chloramphenicol group. Also, the treatment was extended or changed in more cases in the chloramphenicol group than in the other groups. Chloramphenicol was thus inferior to the other three antimicrobials. Ampicillin is a good and cheap alternative, but there are difficulties with resistance. Easy administration tempts the use of ceftriaxone rather than cefotaxime but it causes diarrhoea. A 7-day course of ampicillin, cefotaxime, or ceftriaxone is sufficient in Hib, Mnc, or Pnc meningitis.
 ...
PMID:Randomised comparison of chloramphenicol, ampicillin, cefotaxime, and ceftriaxone for childhood bacterial meningitis. Finnish Study Group. 257 Sep 41

Four hundred twenty-nine patients with bacterial meningitis were assigned on a nonselective alternating basis into one of two therapeutic regimens. Patients in Group I received dexamethasone in addition to standard antibacterial chemotherapy of ampicillin and chloramphenicol whereas those in Group II received antibacterial chemotherapy alone. Dexamethasone was given intramuscularly (8 mg to children younger than 12 years and 12 mg to adults every 12 hours for 3 days). Both treatment groups were comparable with regard to age, sex, duration of symptoms and state of consciousness at the time of hospitalization. A significant reduction in the case fatality rate (P less than 0.01) was observed in patients with pneumococcal meningitis receiving dexamethasone; only 7 of 52 patients died compared with 22 of 54 patients not receiving dexamethasone. A reduction in the overall neurologic sequelae (hearing impairment and paresis) was observed in patients receiving dexamethasone. This reduction was significant only in patients with Streptococcus pneumoniae meningitis; none of the 45 surviving patients receiving steroids had hearing loss whereas 4 of 32 patients not receiving dexamethasone had severe hearing loss (P less than 0.05). No significant difference was observed between the two groups with regard to time for patients to become afebrile or to regain consciousness or in the mean admission and 24- to 36-hour cerebrospinal fluid leukocyte count, glucose or protein content.
 ...
PMID:Dexamethasone treatment for bacterial meningitis in children and adults. 262 85


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>