The Turkish Journal of Pediatrics
2010 , Vol 52 , Num 4
The outcome of bacterial meningitis in children is related to the initial antimicrobial therapy
1Clinic of Infectious Diseases, 2Pediatric Clinic, and 3Radiology Institute, University Hospital Center of Kosova, Prishtinë,
Kosova
Even when highly effective antibiotic therapy is provided to patients, death
and long-term disabilities are common outcomes of acute bacterial meningitis
(BM) in developing countries. The aim of this study was to analyze how the
outcome of disease was related to the initial antimicrobial therapy used to
treat the patients. We analyzed 277 children younger than 16 years of age
who were treated for BM in the Hospital of Infectious Diseases in Prishtina,
Kosova, over a six-year period. Of the 277 children treated for BM, 36.1%
of cases were given initial antimicrobial therapy with one antibiotic, 63.2%
of cases received two antibiotics and 0.7% of the cases received three
antibiotics. Of the 60 patients who had neurologic complications (NC), 50
(28.6%) were treated with two antibiotics, 9 (9%) received one antibiotic
and 1 patient was treated with three antibiotics. The antibiotics used most
often as monotherapy were penicillin G (63 cases) and ceftriaxone (33
cases). The incidence of NC was higher in children treated with ceftriaxone
(NC=22%, mortality [M]=3%) compared with patients treated with penicillin
G (NC=3%, M=0). The most commonly used combination of antibiotics was
ceftriaxone with chloramphenicol (82 cases) followed by penicillin G with
chloramphenicol (63 cases). The incidences of NC and M were higher in
children treated with ceftriaxone and chloramphenicol (NC=43%, M=8%)
compared to children treated with penicillin G and chloramphenicol (NC=13%,
M=3%). The initial treatment of BM with penicillin G did not result in death
and was associated with a lower incidence of NC compared with the use of
ceftriaxone. The combination of penicillin G and chloramphenicol resulted in
a lower incidence of NC and M compared with the combination of ceftriaxone
and chloramphenicol.
Keywords :
bacterial meningitis, treatment, neurologic complication.