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Management of neonatal meningitis, 1984
Abstract:
Neonatal bacterial meningitis continues to cause substantial mortality and morbidity despite the advent of new antimicrobial agents and of modern intensive care facilities. In Dallas, the case-fatality rate for bacterial meningitis in newborn and young infants is 17% (40 of 231 patients). Three pathogens, Group B streptococcus, Escherichia coli and Listeria monocytogenes, accounted for 84% of the causative agents. Although new beta-lactam antibiotics have been extensively evaluated in experimental meningitis due to these pathogens, there is limited clinical experience from which to judge efficacy and safety. Currently, conventional therapy with ampicillin and an amino-glycoside should be used as initial empirical therapy for neonatal meningitis. Once the pathogen has been identified and the susceptibilities determined, the most appropriate antibiotic or combination of antibiotics can be selected. Latamoxef (moxalactam) and cefotaxime are highly active agents in vitro against Gram-negative enteric bacilli and may prove useful for therapy of meningitis due to those organisms. Additional experience with these compounds is required before they can be recommended for routine use.
Insights
Neonatal bacterial meningitis has a high fatality rate, with Group B Streptococcus, E. coli, and Listeria monocytogenes as primary culprits. Conventional ampicillin and aminoglycoside therapy is recommended initially for this serious infant infection.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Neonatal bacterial meningitis remains a significant cause of death and disability in newborns.
- Despite advances in critical care and antimicrobials, case-fatality rates remain high.
Purpose of the Study:
- To review the epidemiology and current treatment strategies for neonatal bacterial meningitis.
- To evaluate the potential role of newer antibiotics like latamoxef and cefotaxime.
Main Methods:
- Retrospective analysis of neonatal meningitis cases.
- Review of in vitro activity of antibiotics against common pathogens.
- Assessment of clinical experience with new beta-lactam antibiotics.
Main Results:
- Group B Streptococcus, Escherichia coli, and Listeria monocytogenes account for 84% of cases.
- The case-fatality rate in Dallas was 17%.
- Newer agents like latamoxef and cefotaxime show in vitro activity against Gram-negative bacilli.
Conclusions:
- Initial empirical therapy for neonatal meningitis should involve ampicillin and an aminoglycoside.
- Specific pathogen identification and susceptibility testing are crucial for targeted antibiotic selection.
- Further clinical data is needed before routine use of latamoxef and cefotaxime can be recommended.