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Management of bacterial meningitis in infants and children. Current status and future prospects
Insights
Bacterial meningitis outcomes in children remain unchanged over 14 years, with persistent high fatality rates. New therapies focusing on reducing brain swelling are needed for improved results in pediatric meningitis cases.
Area of Science:
- Pediatric Infectious Diseases
- Bacterial Meningitis Research
- Clinical Outcomes Analysis
Background:
- Bacterial meningitis outcomes in infants and children showed no significant improvement between 1969 and 1982.
- Case-fatality rates remained substantial despite advances in antimicrobial therapy.
- Neonatal meningitis due to specific bacteria had comparable fatality rates across the study period.
Purpose of the Study:
- To analyze trends in bacterial meningitis outcomes in children over a 14-year period.
- To evaluate the effectiveness of current therapies and identify needs for new treatment strategies.
- To assess the utility of animal models in predicting human therapeutic responses.
Main Methods:
- Retrospective analysis of patient data from Children's Medical Center and Parkland Memorial Hospital (1969-1982).
- Review of antimicrobial susceptibility patterns for common meningitis pathogens.
- Utilized a rabbit model of experimental meningitis to evaluate new antimicrobial agents' efficacy.
Main Results:
- Overall case-fatality rate for bacterial meningitis was 6.4%, with rates of 4.6% (1969-1972) and 3.9% (1981-1982).
- Fatality rates for neonatal meningitis due to group B streptococci and coliform bacilli were similar in both periods.
- Emerging antimicrobial resistance necessitates the development of alternative therapeutic approaches.
Conclusions:
- Current antimicrobial agents, including newer ones like moxalactam, cefotaxime, and ceftriaxone, have not substantially improved meningitis outcomes.
- Future improvements in pediatric bacterial meningitis outcomes are anticipated with therapies targeting cerebral edema and cerebritis.
- Preserving cerebral perfusion pressure and cellular integrity is crucial for better patient outcomes.
Abstract:
Outcome from bacterial meningitis in infants and children has not appreciably changed in a 14-year period from 1969 to 1982 at Children's Medical Center and Parkland Memorial Hospital, Dallas, Texas. Overall, the case-fatality rate was 6.4 percent; it was 4.6 percent for 414 patients managed in 1969 to 1972 and 3.9% for 376 patients in 1981 and 1982. In neonatal meningitis due to group B streptococci or coliform bacilli, the fatality rates were comparable in 1969 to 1972 and 1981 and 1982; ampicillin and an aminoglycoside were the mainstays of therapy during these periods. Because of changing susceptibilities of gram-negative enteric bacilli to the aminoglycosidic agents, Haemophilus influenzae to ampicillin and possibly chloramphenicol and of Streptococcus pneumoniae to penicillin, alternatives to conventional therapy must be developed and thoroughly tested. Assessment of new antimicrobial agents in the rabbit model of experimental meningitis provides valuable information on penetration of drug into cerebrospinal fluid, on achievable bactericidal activity in spinal fluid and on the bacteriologic effect of single dose or nine hour infusion therapy. These data are directly applicable to therapy in infants and children with meningitis. Although newer antimicrobial agents such as moxalactam, cefotaxime, or ceftriaxone have greatly enhanced bactericidal activity against the commonly encountered pathogens, outcome from meningitis will not be substantially improved with therapy using these agents. Improved outcome will more likely occur with the advent of therapeutic modalities that prevent or rapidly decrease cerebral edema and cerebritis, thereby preserving cerebral perfusion pressure and cellular integrity.