Pediatric bacterial meningitis: Is prior antibiotic therapy associated with an altered clinical presentation?

Bacterial Infections of the Central Nervous System

“…It has been demonstrated in human pediatric bacterial meningitis that pretreatment with antibiotics alters the clinical presentation and decreases the occurrence of positive results of the CSF culture. 37 In that report, pretreatment with antibiotics did not, however, alter CSF cell count and glucose or protein concentration. 37 Most commonly, the CSF will be turbid and discolored and will have an increased WBC count, which is predominately neutrophils, as well as an increased neuroanatomic localization dictates.…”

“…37 In that report, pretreatment with antibiotics did not, however, alter CSF cell count and glucose or protein concentration. 37 Most commonly, the CSF will be turbid and discolored and will have an increased WBC count, which is predominately neutrophils, as well as an increased neuroanatomic localization dictates. Signs of osteomyelitis or trauma may be observed, but radiographs will be negative in many cases.…”

Impact of antibiotic therapy on laboratory analysis of parapneumonic pleural fluid in children

“…This finding is important given the significant number of patients who seek medical care for PE and who are already using antibacterial agents. Rothrock and colleagues [16] concluded that biochemical CSF parameters (glucose and protein) are not significantly altered by previous use of antibacterial agents in patients with bacterial meningitis. Similar results were shown by Blazer and colleagues [32] in the assessment of cellularity, glucose, proteins, and the percentage of polymorphonuclear cells in CSF.…”

“…For example, 30% to 55% of children are treated with antibiotics before a laboratory diagnosis of bacterial meningitis is obtained. Cerebrospinal fluid (CSF) cultures have been observed to be sterile in 90% to 100% of patients receiving antibiotic therapy 14 to 48 hours before laboratory analysis [15]; therefore, it is reasonable to suppose that the previous use of antibiotics might delay or even prevent a diagnosis of meningitis [16]. Nevertheless, the effects of previous antibiotic therapy on pleural fluid analysis in pediatric patients have not been studied.…”

Cerebrospinal Fluid Glucose and Protein in Disposition and Treatment Decisions

“…Further query was impossible without injecting bias into the analysis, but it appears that even in those cases where physicians use the results, they sometimes do so inappropriately. 16,17 making these values potentially useful in pretreated patients. Similarly, though CSF protein levels are generally elevated in traumatic lumbar puncture specimens, the CSF glucose is unchanged by the presence of blood and may provide etiologic clues to diagnosis.…”