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Pediatric bacterial meningitis: is prior antibiotic therapy associated with an altered clinical presentation?
S G Rothrock1, S M Green, J Wren
1Department of Emergency Medicine, Loma Linda University Medical Center, California.
Insights
Children treated with oral antibiotics before bacterial meningitis diagnosis show different symptoms. Physicians must recognize these subtle signs for accurate early detection and treatment of pediatric meningitis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Bacterial meningitis is a serious infection in young children.
- Prior antibiotic use can alter the clinical presentation of meningitis.
- Early and accurate diagnosis is crucial for effective treatment and improved outcomes.
Purpose of the Study:
- To compare the clinical features of children with bacterial meningitis who received oral antibiotics before diagnosis versus those who did not.
- To identify key differences that may aid in the diagnosis of meningitis in pretreated children.
Main Methods:
- Retrospective case series of 258 children (≤24 months) with bacterial meningitis over 12 years.
- Data collected from hospital records, including demographics, symptoms, and examination findings.
- Comparison of clinical features between 83 pretreated children and 175 untreated children.
Main Results:
- Pretreated children had lower fever, altered mental status, and longer symptom duration before diagnosis.
- Vomiting, ENT infections, and prior physician visits were more common in pretreated children.
- No significant differences were observed in seizures, specific meningitis signs, mortality, or hospitalization length.
Conclusions:
- Clinical presentation of bacterial meningitis in children differs significantly based on prior antibiotic exposure.
- Healthcare providers should consider pre-existing antibiotic treatment when evaluating young children for meningitis.
- Awareness of these altered features can improve diagnostic accuracy in pediatric meningitis.
Study Hypothesis:
The clinical features of children treated with oral antibiotics before the diagnosis of bacterial meningitis differ from those who receive no antibiotics.
Design:
Retrospective case series.
Setting:
University medical center.
Participants:
Two hundred fifty-eight children 24 months old or younger with bacterial meningitis hospitalized during a 12-year period. Eighty-three children were treated with oral antibiotics before the diagnosis of meningitis, and 175 children were not.
Interventions:
None.
Methods:
The emergency department chart and hospital records were reviewed for presenting demographic, historical, physical examination, and laboratory features. Clinical features of pretreated and untreated patients were compared.
Results:
Pretreated children demonstrated less frequent temperature of 38.3 C or higher, altered mental status and a longer duration of symptoms before diagnosis, with more frequent vomiting; ear, nose, and throat infections; and physician visits in the week before detection of meningitis (P less than .05 for all comparisons). There was no difference in incidence of upper respiratory symptoms, seizures, nuchal rigidity, Kernig's and Brudzinski's signs, focal neurologic signs, mortality, and length of hospitalization between groups.
Conclusion:
Clinical features of children who have taken antibiotics before the detection of meningitis differ significantly from those who have not undergone antibiotic therapy. Physicians should be aware of these differences when evaluating young children on antibiotics for the possibility of meningitis.