The outcome of bacterial meningitis in children is related to the initial antimicrobial therapy

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.