Treatment of childhood bacterial meningitis

Abstract

One hundred and eighty-seven children with identified bacterial meningitis were treated with intravenous cefotaxime: 15 patients were neonates, 79 infants, and 93 were aged from 1 to 14 years. Causative organisms were: Neisseria meningitidis in 80 cases, Streptococcus pneumoniae in 41, Haemophilus influenzae in 40, enteric gram-negative bacilli in 20 and Staphylococcus spp. in six. Enteric gram-negative bacilli included: Salmonella spp. in 14 cases, Klebsiella pneumoniae in two, and Escherichia coli, Enterobacter sakazakii and Acinobacter calcoaceticus in one each; in one case the organism was not specified. Daily dose of cefotaxime was 150 to 300 mg/kg. Concomitant treatment with an aminoglycoside was used in seven cases. One hundred and seventy-two patients (92.0%) were cured. Fever persisted for a mean of five days and meningeal signs for a mean of four days. Fifteen (8.0%) patients died: most [13] of them were admitted in coma, and two in shock. Death occurred in the first 48 h in ten cases. Sterilization of CSF was achieved in the first 72 h of treatment in 155 (90.1%) of the cured patients. Cefotaxime was well tolerated. CSF penetration of cefotaxime was evaluated in seven patients: concentrations ranged from 0.499 mg/l to 2.829 mg/l. Based on this clinical study, cefotaxime is an effective and safe drug for the treatment of childhood bacterial meningitis.

Outbreak History, Biofilm Formation, and Preventive Measures for Control of Cronobacter sakazakii in Infant Formula and Infant Care Settings

“…Among these cases, 15 patients died and two out of the fifteen were infected with C. sakazakii . They both were neonates with infant formula consumption [29].…”

Clinical Characteristics, Acute Complications, and Neurologic Outcomes of Salmonella Meningitis in Saudi Infants and Children

“…In their study on childhood meningitis, Lecour et al reported the case fatality rate for Salmonella meningitis in patients treated with cefotaxime as 28.6%, which is similar to that reported in our study. 20 In our cases the disease progressed in 12 patients despite conventional ceftriaxone treatment. Subdural empyema, cerebral infarcts, and venous thrombosis developed while patients were on ceftriaxone.…”

“…Use of fluoroquinolones, mainly ciprofloxacin in Salmonella meningitis, has increased, particularly in cases where there seems to be no clinical response to other antibiotics. 8,[18][19][20] An advantage of fluoroquinolones is the achievable intracellular diffusion. Carbapenems, mainly meropenem, have also been described as therapeutic alternative with good outcome.…”

Detection of <i>Enterobacter sakazakii</i> from Commercial Children Dry Milk

“…Used in the study [5], this was identical to the present study in the case reported cephalosporins, such as cefepime, in collection with a second agent. Two studies in [15] and [2], supported the use of cefotaxime for childhood bacterial meningitis. In each of these studies, Enterobacter sakazakii meningitis was identified in at least 1 child, and the infection was treated successfully.…”

“…Enterobacter sakazakii is a gram-negative bacteria, motile, non-spore forming, facultatively anaerobic, bacillus forming yellow pigmented colonies after 24 -48 hours at 37˚C incubation on a non-selective medium rod that was formerly known as "yellow-pigmented Enterobacter cloacae" until 1980 [1]. This bacterium is an emerging opportunistic pathogen predominantly associated with bacterial meningitis in immune compromised neonates [2]. Other clinical presentations of infection include bacteremia and necrotizing enterocolitis [3].…”