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Occurrence of multiple antimicrobial resistance among Haemophilus influenzae type b causing meningitis
R Singh1, S Thomas, C Kirubakaran
1Department of Child Health, Christian Medical College & Hospital, Vellore.
Abstract:
Among the 157 children with culture proven pyogenic meningitis who were admitted during 1987-1991, in the Department of Child Health at the Christian Medical College and Hospital, Vellore, 40 had H. influenzae type b (HIB) meningitis; 17 of these had multiantimicrobial resistant HIB (MRHIB) and 23 others had usual susceptibility HIB (USHIB) meningitis. The two groups were compared. Children with MRHIB meningitis who received optimal treatment with cefotaxime had excellent recovery. When cefotaxime therapy was delayed, mortality was noted in all except one child who survived with severe neurological sequelae. MRHIB meningitis treated with drugs other than cefotaxime had 100 per cent mortality. Cefotaxime is therefore recommended in children below 3 yr of age presenting with purulent meningitis, as MRHIB is a possible causative agent in this group.
Insights
Multi-antimicrobial resistant Haemophilus influenzae type b (MRHIB) meningitis in children requires prompt cefotaxime treatment for excellent recovery. Delayed or alternative antibiotic treatment leads to high mortality or severe neurological sequelae.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Pyogenic meningitis is a significant cause of childhood morbidity and mortality.
- Haemophilus influenzae type b (HIB) is a common pathogen, with increasing antimicrobial resistance observed.
- Multi-antimicrobial resistant HIB (MRHIB) poses a therapeutic challenge.
Purpose of the Study:
- To compare outcomes of MRHIB meningitis versus usual susceptibility HIB (USHIB) meningitis.
- To evaluate the efficacy of cefotaxime in treating MRHIB meningitis.
- To establish treatment recommendations for MRHIB meningitis in children.
Main Methods:
- Retrospective analysis of 157 children with culture-proven pyogenic meningitis admitted between 1987-1991.
- Comparison of outcomes between MRHIB and USHIB meningitis groups.
- Assessment of treatment regimens, focusing on cefotaxime use and timing.
Main Results:
- Out of 157 children, 40 had HIB meningitis, with 17 cases of MRHIB.
- Children with MRHIB meningitis treated promptly with cefotaxime showed excellent recovery.
- Delayed cefotaxime therapy resulted in high mortality (all but one survivor with sequelae).
- MRHIB meningitis treated with non-cefotaxime antibiotics had 100% mortality.
Conclusions:
- Prompt cefotaxime administration is crucial for favorable outcomes in MRHIB meningitis.
- Cefotaxime is recommended for children under 3 years with purulent meningitis, considering MRHIB as a potential pathogen.
- Antimicrobial stewardship is vital to combat rising resistance in HIB meningitis.