Bacterial meningitis, treatment

Pediatric Doses of Selected Agents Used in Bacterial Meningitis Treatment... 

The treatment of bacterial infections of the central nervous system highlights a number of important therapeutic considerations. Bacterial meningitis is caused by a variety of bacteria although their incidence varies with age. In the neonate, E. coli and group B streptococci account for the majority of infections, while in the preschool child H. influenzae is the commonest pathogen. Neisseria meningitidis has a... 

See Table 67-1 for empirical treatment recommendations. cSee text for specific recommendations for use of adjunctive dexamethasone in adults with bacterial meningitis. dSee Table 67-3 for pathogen-based definitive treatment recommendations. (Adapted, with permission, ref. 14.)... 

Sinner SW, Tunkel AR. Antimicrobial agents in the treatment of bacterial meningitis. Infect Dis Clin North Am 2004 18 581-602. 

In the treatment of bacterial meningitis in children, the drug of choice is... 

Seizures Seizures and other CNS adverse experiences have been reported during treatment with meropenem. These adverse experiences have occurred most commonly in patients with CNS disorders (eg, brain lesions or history of seizures) or with bacterial meningitis or compromised renal function. 

Bacterial meningitis remains a very important disease worldwide. Attack rates of 46 cases per 100,000 population with a case fatality rate of 33% have been described. Early recognition and prompt treatment remain essential for the prognosis of this serious illness. 

Because of potential toxicity, bacterial resistance, and the availability of many other effective alternatives, chloramphenicol is rarely used. It may be considered for treatment of serious rickettsial infections such as typhus and Rocky Mountain spotted fever. It is an alternative to a B-lactam antibiotic for treatment of meningococcal meningitis occurring in patients who have major hypersensitivity reactions to penicillin or bacterial meningitis caused by penicillin-resistant strains of pneumococci. The dosage is 50-100 mg/kg/d in four divided doses. 

In the early part of the twentieth century the synthesis of sulfonamide drugs such as anti-bacterials led to the first effective treatments of the fatal diseases septicaemia, bacterial meningitis and the killer disease, pneumonia. The active form of the drug is p-aminobenzenesulphonamide (Figure 14.4). 

Selectin-dependent adhesion inhibitors offer a new therapeutical approach to the prevention of transplant rejection. They should also enable treatment and prophylaxis of various other pathological inflammation processes and diseases (i.e. rheumatic arthritis, dermatitis and bacterial meningitis) initiated by a massive invasion of leucocytes [1,7]. 

Randomized trials and systematic reviews of trials, therefore, provide the most reliable data on the effects of treatment. That is not to say, however, that non-randomized studies cannot sometimes provide reliable evidence on the benefits of intervention. Few people would doubt the validity of the observational data on the benefits of antibiotic treatment in bacterial meningitis or the benefits of treatment with levodopa in Parkinson s disease. Similarly, clinical guidelines have been revised worldwide on the basis of the non-randomized evidence of the substantial reduction in the risk of early recurrent stroke (see Fig. 19.2, p. 245) as a result of the urgent initiation of standard secondary prevention (Rothwell et al. 2007). 

Chloramphenicol is used far the treatment of typhoid fever, bacterial meningitis, and certain anaerobic infections such as in the treatment of cystic fibrosis in children. 

A drug is more likely to cross into the central nervous system (CNS) of a neonate rather than an older child or an adult. This most likely occurs because its CNS is less mature and the blood-brain barrier is less formed. This is an important consideration when antimicrobial therapy is needed for the treatment of bacterial meningitis or anticonvulsant for seizures. 

Saez-Llorens X, Castano E, Garcia R, Baez C, Perez M, Tejeira F, McCracken GH Jr. Prospective randomized comparison of cefepime and cefotaxime for treatment of bacterial meningitis in infants and children. Antimicrob Agents Chemother 1995 39(4) 937 0. 

Wong VK, Wright HT Jr, Ross LA, Mason WH, InderUed CB, Kim KS. Imipenem/cilastatin treatment of bacterial meningitis in children. Pediatr Infect Dis J 1991 10(2) 122-5. 

Klugman KP, Dagan R. Randomized comparison of meropenem with cefotaxime for treatment of bacterial meningitis. Meropenem Meningitis Study Group. Antimicrob Agents Chemother 1995 39(5) 1140-6. 

Schaad UB, Suter S, Gianella-Borradori A, Pfenninger J, Auckenthaler R, Bernath O, Cheseaux JJ, Wedgwood J. A comparison of ceftriaxone and cefuroxime for the treatment of bacterial meningitis in children. N Engl J Med 1990 322(3) 141-7. 

In a study of the intrathecal administration of colistin adverse events were not reported (36). This may be an effective alternative treatment of bacterial meningitis caused by multidrug-resistant Gram-negative rods. 

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