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Five days of antibacterial therapy for bacterial meningitis in children?
I Lutsar1, A Gontmacher, M Närska
1Tartu University Children's Hospital, Estonia.
Abstract:
We evaluated the effectiveness of 5-day antibacterial therapy for bacterial meningitis in children. The study group included 26 children from 2 months to 15 years of age, admitted with microbiologically confirmed bacterial meningitis in 1990-1993 and treated for 5 days. A historical comparison group of 49 patients treated for 8 to 15 days was used. Penicillin monotherapy (300 mg/kg body weight) was used for meningococcal and pneumococcal meningitis and ampicillin (300 mg/kg body weight) for Haemophilus influenzae b meningitis. On day 5 of therapy the activity of aspartate aminotransferase (AST), lactic dehydrogenase (LDH), creatine phosphokinase (CPK) and gamma-glutamyl-transpeptidase (gamma GT) in the CSF was determined by photocolorimetric assay and the concentration of creatine kinase BB (CK-BB) by ELISA. IL-6 was analysed using EIA technique and a cerebral ultrasound was performed at the time of the termination of the antibacterial therapy. The mean follow-up time was 1.3 years for children in the study group and 3.2 in the control group. The time of hospitalisation was shorter in children treated for 5 days (p < 0.005). Complete clinical recovery was 81% in the study group and 66% in the comparison group at the time of the termination of antibacterial therapy. No relapses occurred. The activity of AST, CPK, LDH, and gamma GT in the CSF had returned to normal by the 5th day of therapy, but almost a 7-fold higher concentration of CK-BB was registered. The concentration of IL-6 in the CSF decreased with the therapy from 1,800 pg/ml to 685 pg/ml but still remained high.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
A 5-day antibacterial therapy for bacterial meningitis in children resulted in shorter hospital stays and improved recovery rates compared to longer treatments. This approach demonstrated effectiveness in pediatric bacterial meningitis cases.
Area of Science:
- Pediatric Infectious Diseases
- Neuroscience
- Clinical Microbiology
Background:
- Bacterial meningitis remains a significant cause of childhood morbidity and mortality.
- Optimal duration of antibacterial therapy for pediatric bacterial meningitis is crucial for effective treatment and minimizing sequelae.
- Previous treatment protocols involved longer durations, necessitating evaluation of shorter, effective regimens.
Purpose of the Study:
- To evaluate the effectiveness of a 5-day antibacterial therapy regimen for bacterial meningitis in children.
- To compare clinical recovery and neurological markers in children treated with a 5-day versus an 8–15 day course of antibiotics.
Main Methods:
- A study group of 26 children (2 months–15 years) with microbiologically confirmed bacterial meningitis received 5-day therapy.
- A historical comparison group of 49 patients received 8–15 days of therapy.
- Cerebrospinal fluid (CSF) analysis included enzyme activity (AST, LDH, CPK, gamma GT) and cytokine levels (IL-6). Creatine kinase BB (CK-BB) was measured by ELISA.
- Cerebral ultrasound was performed at therapy termination.
Main Results:
- Children treated for 5 days had significantly shorter hospitalization times (p < 0.005).
- Complete clinical recovery was higher in the 5-day group (81%) compared to the comparison group (66%).
- CSF enzyme levels (AST, CPK, LDH, gamma GT) normalized by day 5, though CK-BB remained elevated; IL-6 levels decreased but remained high.
Conclusions:
- A 5-day antibacterial therapy is effective for treating bacterial meningitis in children.
- This shorter regimen leads to improved clinical outcomes and reduced hospitalization duration.
- Further research into the long-term neurological impact and optimal management of elevated CSF markers is warranted.