Five days of antibacterial therapy for bacterial meningitis in children?

Abstract

We evaluated the effectiveness of 5-day antibacterial therapy for bacterial meningitis in children. The study group included 26 children from 2 months to 15 years of age, admitted with microbiologically confirmed bacterial meningitis in 1990-1993 and treated for 5 days. A historical comparison group of 49 patients treated for 8 to 15 days was used. Penicillin monotherapy (300 mg/kg body weight) was used for meningococcal and pneumococcal meningitis and ampicillin (300 mg/kg body weight) for Haemophilus influenzae b meningitis. On day 5 of therapy the activity of aspartate aminotransferase (AST), lactic dehydrogenase (LDH), creatine phosphokinase (CPK) and gamma-glutamyl-transpeptidase (gamma GT) in the CSF was determined by photocolorimetric assay and the concentration of creatine kinase BB (CK-BB) by ELISA. IL-6 was analysed using EIA technique and a cerebral ultrasound was performed at the time of the termination of the antibacterial therapy. The mean follow-up time was 1.3 years for children in the study group and 3.2 in the control group. The time of hospitalisation was shorter in children treated for 5 days (p < 0.005). Complete clinical recovery was 81% in the study group and 66% in the comparison group at the time of the termination of antibacterial therapy. No relapses occurred. The activity of AST, CPK, LDH, and gamma GT in the CSF had returned to normal by the 5th day of therapy, but almost a 7-fold higher concentration of CK-BB was registered. The concentration of IL-6 in the CSF decreased with the therapy from 1,800 pg/ml to 685 pg/ml but still remained high.(ABSTRACT TRUNCATED AT 250 WORDS)

Urine stability for metabolomic studies: effects of preparation and storage

“…Processing of the urine and storage in the refrigerator or deep-freeze helped to reduce the rise in lactate when compared to raw urine at room temperature (table 4). An increase in lactate has been shown to correlate with bacterial activity in a number of pathophysiologies; such as bacteraemia (Bar-Meir et al, 2005), urinary tract infections (Tal et al, 2005), pneumonia (Utine et al, 2005), and meningitis (Lutsar et al, 1995;Nazifi et al, 1997).…”

Short versus long duration of antibiotic therapy for bacterial meningitis: a meta-analysis of randomised controlled trials in children

“…In fact, in the RCT included in our meta-analysis that provided relevant data, early repeat CSF cultures were negative 15 17. Besides, it should be noted that inflammatory CSF changes,23 25 as well as certain clinical manifestations,23 29 might persist after the eradication of causative pathogens from the CSF and, therefore, these parameters might not be accurate markers of the effectiveness of therapy.…”

Antimicrobials in the management of invasive meningococcal disease

“…For meningococcal meningitis in adults and in older children, data gleaned from retrospective and prospective studies suggest that treatment for 5 days, or perhaps less, is likely to be safe. [16][17][18][19][20][21][22] There are inadequate age-specific data in these studies for younger infants and children to draw conclusions about time to sterility after commencement of antimicrobial therapy. Meningococcal meningitis in neonates adds a new challenge.…”