Initial Chemotherapy for Purulent Meningitis in Children

Abstract

The combination of ampicillin with either gentamicin or chloramphenicol, which is currently the initial chemotherapy for purulent meningitis, has lost its effectiveness in recent years because of an increase in the incidence of ampicillin-resistant strains. This has made it necessary to search for a suitable substitute therapy.Twenty-two new P-lactam agents were compared with penicillin G and ampicillin in terms of their antibacterial activity in relation to the principal causative microbes of meningitis and their ability to transfer into the cerebrospinal fluid (CSF) of rabbits with experimental staphylococcal meningitis. In addition, a survey was conducted of the therapeutic efficacy achieved by these drugs in cases seen by the authors and in other domestic and overseas cases. Finally, an investigation was made as to whether or not the transfer of the drug into the CSF was suppressed when it was administered simultaneously with ampicillin.From the results, it was surmised that in future the most appropriate initial chemotherapy for purulent meningitis will be a combination of cefotaxime, or perhaps ceftriaxone, plus ampicillin.

Meningococcal disease in Asia: an under-recognized public health burden

“…Records available since before 1920 show between 300 and 1500 meningococcal cases per year between 1920 and the early 1960s, with a peak in 1945 and around 1947 with about 4500 cases and 3500 cases, respectively [ 34 , 105 ]. After 1970 the number of reported cases fell to <100, with fewer than 30 cases per year reported since 1980 [ 34 , 106 , 107 ]. There is little seasonal variation in case numbers or mortality [ 34 ].…”

“…Nationwide and local retrospective surveys of bacterial meningitis have been performed regularly via questionnaires sent to medical institutions [ 105 , 107 – 120 ]. According to these surveys, the proportion of bacterial meningitis cases due to N. meningitidis since the 1990s has remained below 2%.…”

“…Low rates of meningococcal disease have also been observed in hospital-based studies [ 121 ]. Under-reporting has been suggested due to problems associated with handling and laboratory detection of N. meningitidis and use of antibiotics prior to culture [ 105 , 107 , 120 ]. However, in a study of 168 CSF samples obtained from patients of all ages throughout Japan from 2005 to 2007 that were evaluated using PCR, no N. meningitidis was identified (0/121 positive samples) [ 122 ].…”