Seven versus Ten Days Antibiotics Course for Acute Pyogenic Meningitis in Children: A Randomized Controlled Trial
N D Vaswani1, Nishu Gupta2, Ravi Yadav1
1Department of Pediatrics, PGIMS, Rohtak, Haryana, India.
Insights
A shorter, 7-day antibiotic course is as effective as a 10-day course for treating acute pyogenic meningitis in children with rapid initial recovery, showing similar treatment failure rates and long-term outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacology
- Microbiology
Background:
- Acute pyogenic meningitis is a serious infection in children.
- Empirical antibiotic therapy duration is a key treatment consideration.
- Optimizing antibiotic courses can improve patient outcomes and reduce resistance.
Purpose of the Study:
- To compare the efficacy and safety of 7-day versus 10-day empirical antibiotic therapy for acute pyogenic meningitis in children.
- To evaluate treatment failure, relapse rates, and long-term sequelae in pediatric meningitis patients.
Main Methods:
- A randomized trial involving 96 children (3 months to 14 years) with acute pyogenic meningitis.
- Patients received either 7 or 10 days of antibiotic therapy.
- Outcomes included treatment failure, relapse within 2 weeks of discharge, and sequelae at 30 and 90 days.
Main Results:
- No statistically significant difference in treatment failure or relapse rates between the 7-day (7/48) and 10-day (6/48) groups.
- No significant differences in hearing impairment, hydrocephalus, or neurological sequelae between groups at follow-up.
- Four cases of nosocomial sepsis occurred, with two in each treatment group.
Conclusions:
- A 7-day empirical antibiotic therapy course is as effective and safe as a 10-day course for children with acute pyogenic meningitis and rapid initial recovery.
- Short-course antibiotic therapy may be sufficient for treating non-neonatal acute pyogenic meningitis in select pediatric populations.
Objectives:
To compare the efficacy and safety of 7 d vs. 10 d empirical antibiotic therapy in cases of acute pyogenic meningitis in children aged 3 mo to 14 y with rapid initial recovery.
Methods:
A total of 96 children aged 3 mo to 14 y with acute pyogenic meningitis were randomized to either 7 d or 10 d therapy on Day 5 of the therapy, if they were in clinical remission and had improving cerebrospinal fluid (CSF) abnormalities. The primary outcome was treatment failure in each group within 10 d of enrolment or relapse of meningitis defined as recurrence of signs and symptoms of meningitis within 2 wk of discharge. Secondary outcome was the presence of sequelae in patient at 30 d and 90 d follow-up post discharge.
Results:
Out of 111 screened children, 96 patients completed the trial, 48 in each group. There were 7 treatment failures and relapses each in the group receiving 7 d antibiotics while 6 failures and relapses each were seen in 10 d antibiotics group. There was no statistically significant difference in treatment failure in both the groups [2.1 (-0.12-0.16); p = 0.76]. No deaths or significant adverse effects of the drugs occurred during this study. Four cases of nosocomial sepsis were reported with 2 cases in each group. On subsequent 30 d and 90 d follow-up, no statistically significant difference was found between the two groups regarding frequency of hearing impairment, frequency of hydrocephalus [-2.1 (-0.09-0.13); p = 0.65] and various neurological sequelae [6.2 (-0.06-0.19); p > 0.05].
Conclusions:
Short course antibiotic therapy may be adequately effective for treatment of acute pyogenic meningitis beyond neonatal age in children with initial rapid recovery.
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