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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

In infants and children, the absorption, distribution, metabolism, and excretion of drugs may differ considerably in comparison with these factors in adults; consequently, differences exist in therapeutic efficacy and toxicity of various antibiotic agents. Because of known toxicity, certain drugs--such as chloramphenicol in high doses, the sulfonamides, and tetracycline--should not be used in neonates. Antibiotic therapy should be modified in neonates because of biologic immaturity of organs important for the termination of drug action. Because of poor conjugation, inactivation, or excretion, the serum concentrations of many antibiotics may be higher and more prolonged in neonates than in older infants; thus, lower doses and longer intervals between administration may be necessary. In this article, we suggest dosages of antimicrobial agents for severe infections in children, older infants, and neonates. Included in the discussion are the cephalosporins, especially the third-generation cephalosporins that have assumed an important role in empiric treatment of bacterial meningitis in pediatric patients because of their ability to penetrate the central nervous system and their effectiveness against beta-lactamase-positive and negative strains of Haemophilus influenzae type b, Streptococcus pneumoniae, Neisseria meningitidis, and many gram-negative bacteria in the Enterobacteriaceae group. In patients with congenital or acquired immunodeficiencies, antifungal, antiviral, or anti-Pneumocystis agents are often added to the antimicrobial regimen for severe infections. We review the agents available for such treatment in children, the drugs used for childhood tuberculosis, and certain new antibiotics (aztreonam, ticarcillin-clavulanate, ciprofloxacin, and imipenem-cilastatin) that have proved useful in select cases but whose precise role in pediatric practice will necessitate additional clinical experience.
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PMID:Antibiotic therapy for severe infections in infants and children. 173 93

Antibiotic susceptibilities of 38 type b Haemophilus influenzae and 28 Streptococcus pneumoniae strains isolated from cerebrospinal fluid, blood and other specimens between 1973 and 1988 were studied. Minimal inhibitory concentrations (MICs) of ampicillin against 10 beta-lactamase positive and 28 negative H. influenzae isolates were 32-64 and 0.25 micrograms/ml, respectively. The MIC of chloramphenicol against one of the beta-lactamase positive H. influenzae strains was 8 but MICs against the rest of the organisms were 0.5-1 micrograms/ml. MICs of cefotaxime, ceftriaxone and cefuroxime against all H. influenzae strains were 0.016, 0.008 and 0.5 micrograms/ml, respectively. No S. pneumoniae isolates were resistant to penicillin G and MICs of this drug were 0.016-0.032 micrograms/ml. MICs of cefotaxime, cefriaxone and cefuroxime against all S. pneumoniae strains were 0.016-0.032, 0.016-0.032 and 0.032-0.063 micrograms/ml, respectively. MICs of chloramphenicol against 15, 4 and 9 of S. pneumoniae isolates were 2, 8 and 16 micrograms/ml, respectively. Antibiotic concentrations in the cerebrospinal fluid of patients with bacterial meningitis after intravenous administration of ampicillin (50-70 mg/kg x 4/day), penicillin G (31-63 mg/kg x 4/day), cefotaxime (50 mg/kg x 4/day) and chloramphenicol (25 mg/kg x 4/day) were 4.70 +/- 1.83 (n = 11), 0.57 +/- 0.32 (n = 7), 4.97 +/- 2.60 (n = 9) and 8.52 +/- 3.54 micrograms/ml (n = 3), respectively. The initial choice of antibiotics in older children with bacterial meningitis is a combination of ampicillin (75 mg/kg x 4/day) and cefotaxime (50 mg/kg x 4/day) to cover ampicillin-resistant H. influenzae, S. pneumoniae, and Listeria monocytogenes in Japan. These antibiotics should be changed according to the causative organisms and their antibiotic susceptibilities.
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PMID:Antibiotic susceptibility of type b Haemophilus influenzae and Streptococcus pneumoniae, and antibiotic concentration in cerebrospinal fluid. 211 62

Staphylococcus aureus is a relatively uncommon cause of meningitis associated with high mortality in neonates and neurosurgical patients. The infrequency of this infection has made its study difficult and has complicated the issues of treatment and prognosis. We reviewed 28 cases of S. aureus meningitis occurring over a 10-year period at three hospitals. Eight cases in children and 20 in adults were identified. Seventy-five percent of the children and 35% of the adults had central nervous system trauma or surgery; 45% of adults had comorbid disease that might have predisposed them to infection. Clinical presentation did not distinguish this form of meningitis from other bacterial meningitides. Findings in cerebrospinal fluid were characteristic of acute bacterial meningitis. Blood cultures were positive in 65% of cases. Overall mortality was 37%; 50% of adults but no children died of meningitis. No patients with S. aureus meningitis complicating cerebrospinal fluid shunts died; however, nine of 11 patients with identifiable foci of infection outside the central nervous system died. Only one patient receiving initial treatment with a penicillinase-resistant penicillin died of meningitis, whereas six of 12 patients not so treated died.
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PMID:Staphylococcus aureus meningitis: review of 28 cases. 268 44

Fifty-seven patients with bacterial meningitis were treated with once daily ceftriaxone. After an initial loading dose of 100 mg/kg, the patients received 80 mg/kg as a single daily dose. Etiologic agents included: Haemophilus influenzae type b, 37 (11 beta-lactamase-positive); Neisseria meningitidis, 11; Streptococcus pneumoniae, 6; Streptococcus pyogenes, 1; Haemophilus influenzae type f, 1; and Group B Streptococcus, 1. All patients showed clinical improvement and all were bacteriologically cured. Satisfactory cerebrospinal fluid bactericidal activity and drug concentrations were seen 24 hours after a dose even in those patients in whom repeat spinal taps were carried out following the last dose of therapy. The drug was well-tolerated and the major adverse effect seen was diarrhea in 20.4% of the patients. The diarrhea was mild and self-limited and did not necessitate discontinuation of the drug although it was frequently associated with alterations in the stool microbiologic flora. Based on this preliminary experience, ceftriaxone, when given in a single daily dose, appears safe and effective in the treatment of bacterial meningitis in nonneonatal infants and children.
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PMID:Safety and efficacy of once daily ceftriaxone for the treatment of bacterial meningitis. 308 48

One hundred and forty-five episodes of acute bacterial meningitis in children seen over a 13 year period are reviewed. The mortality rate was 1.4%. Over the study period H influenzae type b remained as the dominant causative organism, with 11% of the isolates being beta-lactamase positive. The difficulties in diagnosis in children, the sequelae of sensorineural deafness and continued morbidity in this disorder are stressed.
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PMID:Bacterial meningitis in childhood: a 13 year review. 318 33

Hemophilus influenzae type B is no longer considered a rare cause of adult meningitis. Clinical presentation is no different from that of other types of bacterial meningitis. When H influenzae is suspected on the basis of CSF examination, the preferred treatment is chloramphenicol (Chloromycetin) with or without ampicillin until ampicillin susceptibility or beta-lactamase production is determined.
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PMID:Hemophilus influenzae meningitis in an adult. 348 22

Since November 1982 at the Sainte-Justine Hospital in Montreal, ampicillin and cefotaxime were used in association as initial treatment (greater than or equal to 48 h) for childhood bacterial meningitis. In this report is described the in vitro interaction of the new regimen in comparison with that of the previous ampicillin-chloramphenicol combination against 284 Haemophilus isolates. Among the 156 ampicillin-susceptible, beta-lactamase-negative isolates, synergy was detected in 13 with ampicillin-cefotaxime, and antagonism was detected in only 1; in contrast, synergy was found in only 2 strains with ampicillin-chloramphenicol, and antagonism was found in 15. These differences were statistically significant (P less than 0.01). Such significant differences were not observed among the 128 ampicillin-resistant, beta-lactamase-positive Haemophilus isolates. The synergy of ampicillin-cefotaxime did not contribute to a decrease of the MIC of cefotaxime for 90% of isolates tested, whereas the antagonism of ampicillin-chloramphenicol did not contribute to increase the MIC of ampicillin for 90% of isolates tested.
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PMID:In vitro comparison of ampicillin-chloramphenicol and ampicillin-cefotaxime against 284 Haemophilus isolates. 348 30

Despite the apparent success of several new cephalosporins in the treatment of Gram-negative bacterial meningitis, four treatment failures with cefotaxime or latamoxef were encountered (two caused by Enterobacter and two by Serratia spp.) In-vitro parameters of susceptibility of these clinical isolates were compared with those of a meningeal Ent. cloacae isolate from a successfully treated patient. The MIC and MBC values, degrees of inoculum effect, and amounts of beta-lactamase produced correlated poorly with the observed clinical outcome. However, the extent to which an isolate was killed by the cephalosporin used for treatment, in a 6-h in-vitro incubation, showed good correlation. We suggest that such a test should be used to predict clinical outcome of therapy because the other parameters such as the MIC and MBC values are not sufficiently discriminatory.
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PMID:Treatment failures of cefotaxime and latamoxef in meningitis caused by Enterobacter and Serratia spp. 350 99

In a multicenter randomized trial, 107 children with bacterial meningitis were initially given either cefuroxime or ampicillin plus chloramphenicol. Patients were alternately assigned to 7- or 10-day courses of the designated antimicrobial regimen. CSF isolates included Haemophilus influenzae type b (89, of which 25% were beta-lactamase positive), Streptococcus pneumoniae, and Neisseria meningitidis. Although mean CSF bactericidal titers against Haemophilus isolates were 1:6 in each treatment group, H. influenzae was cultured from CSF in four of 39 patients receiving cefuroxime, 24 to 48 hours after initiation of therapy, compared with none of 40 patients given ampicillin plus chloramphenicol (P = 0.11). Clinical cure rates were similar (95%); one death occurred in each group. One child given cefuroxime had persistent meningitis after 5 days of therapy, and mastoiditis with secondary bacteremia developed in one on day 10. Three patients had relapse or reinfection. One patient who received cefuroxime for 10 days had a relapse of epiglottitis 17 days later, and of the patients given ampicillin plus chloramphenicol, one had a relapse of meningitis 1 week after 7 days of therapy, and bacteremia developed in one 42 days after completion of 10 days of therapy. No increase in either in-hospital complications or relapses occurred with a 7-day treatment course. Proof of the equivalence of the antibiotic regimens and the efficacy of 7-day courses of treatment, as well as the consequences of delayed CSF sterilization, will require additional investigation.
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PMID:Cefuroxime versus ampicillin plus chloramphenicol in childhood bacterial meningitis: a multicenter randomized controlled trial. 352 32


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