HAEMOPHILUS INFLUENZAE MENINGITIS A Comparison between Chloramphenicol and Ampicillin Therapy with Special Reference to Impaired Hearing

Abstract

131 patients suffering from meningitis due to Haemophilus influenzae or parainfluenzae were re-examined after 1-15 years, using hospital records, questionnaires, and audiological examination, especially to compare chloramphenicol and ampicillin therapy. Mortality was 3.8%. Subdural effusions occurred in 14.5% of cases uni- or bilaterally. There was deafness in 2.3%, and moderate hearing loss in 8.4%. Convulsions appeared later in 6.9%. The final outcome was good in 60%. The most important factors in prognosis seemed to be the severity of the symptoms and the condition of the patient on admission to hospital. No clear difference was seen between the results of chloramphenicol and ampicillin therapy, but total loss of vestibular function was found in 3 cases in the ampicillin group, and in none in the chloramphenicol group. In mortality and deafness, the differences in outcome were similar, although not statistically significant. As these observations show, the therapy used in Haemophilus influenzae meningitis needs re-evaluation.

Global Case Fatality of Bacterial Meningitis During an 80-Year Period

“…We found additional studies specifically reporting on S pneumoniae (113 studies; 24 553 episodes) (eTable 8 in Supplement 1), N meningitidis (75 studies; 100 278 episodes) (eTable 9 in Supplement 1), H influenzae (49 studies; 28 796 episodes) (eTable 10 in Supplement 1), L monocytogenes (15 studies; 985 episodes) (eTable 11 in Supplement 1),…”

“…H influenzae was among the most frequent pathogens in children (226 of 630 studies [36%]; 249 of 733 study periods [34%]; 49 539 of 314 454 episodes [16%]) (eTable 18 and eFigure 32 in Supplement 1). The overall CFR was 11% (95% CI, 10% to 13%) (eFigure 33 in Supplement 1); CFR was 13% (95% CI, 10% to 18%) before 1961 and 10% (95% CI, 7% to 16%) after 2010. CFR was higher in low-income countries (23%; 95% CI, 19% to 29%) compared with high-income countries (7%; 95% CI, 5% to 9%) (eTable 19 in Supplement 1) and did not decrease substantially during the period (0.7% per year; 95% CI, −0.3% to 1.7% per year; P = .17) (eFigures 34 to 36 in Supplement 1).…”

Hearing Disorders After Haemophilus influenzae Meningitis: Comparison of Different Drug Regimens

“…Loss of hearing was recognized in 11 (five chloramphenicol-treated, six ampicillintreated) and suspected in another 4 (one chloramphenicol-treated, three ampicillin-treated). 11 A, 6; C, 6 A, 35; C, 50 A, 31; C, 25 "1 = professional/managerial; 2 = clerical/technicians; 3 = semiskilled/unskilled workers. f1 = good condition; 2 = tired, high fever; 3 = reacting poorly, unconscious.…”

Bacterial Meningitis and Hearing Impairment: A Prospective Study

“…Several retrospective studies suggested that ampicillin was responsible for the hearing loss [13]. However, more recent studies showed no differences of the incidence of post-meningitis deafness and the various forms of antimicrobial therapy [4,5,12].…”