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Bacterial meningitis in children in southern Ghana
J O Commey1, O P Rodrigues, F A Akita
1Department of Child Health, University of Ghana Medical School, Accra.
Insights
Bacterial meningitis in children is often caused by S. pneumoniae and Neisseria meningitides. Early antibiotic treatment, particularly with ceftriaxone, improves outcomes and reduces mortality in pediatric meningitis cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Bacterial meningitis poses a significant threat to children, particularly in resource-limited settings.
- Delayed presentation to healthcare facilities is common, impacting treatment efficacy.
Purpose of the Study:
- To identify the causative organisms of bacterial meningitis in children admitted to Korle Bu Teaching Hospital.
- To evaluate the effectiveness of different antibiotic regimens and identify optimal treatment strategies.
Main Methods:
- Retrospective analysis of 103 pediatric bacterial meningitis cases over 17 months.
- Identification of bacterial pathogens and antimicrobial susceptibility testing.
- Comparison of treatment outcomes across different antibiotic regimens.
Main Results:
- Strengths. pneumoniae and Neisseria meningitides were the predominant pathogens.
- Ceftriaxone demonstrated high efficacy, with all isolates sensitive to it.
- Case fatality rate was 22%, with deaths often occurring rapidly after admission.
- Neurological complications affected 22% of survivors.
Conclusions:
- Early initiation of appropriate antibiotic therapy is crucial for improving outcomes in pediatric bacterial meningitis.
- Ceftriaxone is a highly effective antibiotic and should be considered a first-choice treatment globally.
- Further research into optimal treatment timing and antibiotic selection is warranted.
Abstract:
One hundred and three children (1% of seriously ill children referred to the Korle Bu Teaching Hospital in Accra) were admitted with bacterial meningitis over a 17 month period. 43 of these children had been ill for more than 4 days before arrival at our centre. The main causative organisms were S. pneumoniae (47.9%), Neisseria meningitides (38.4%) and Haemophilus influenzae (9.6%). All bacterial isolates were highly sensitive to ceftriaxone. Resistance to penicillin and chloramphenicol was however present in 5-17% of isolates. All cerebrospinal fluid samples were sterilised within 48 hours of antibiotic treatment. Case fatality rate was 22% with the majority of deaths occurring within hours of admission and closely related to S. pneumoniae infection. Neurological complications occurred in 22%; mild diarrhoea in 33% and secondary fever in 14.8% of survivors. No significant difference was noted among the three treatment regimens of ceftriaxone alone, penicillin plus chloramphenicol, and ceftriaxone alone for 48 hours followed by penicillin/chloramphenicol combination. Our overall outcome would have been better if patients had been started on appropriate antibiotic treatment within the earlier hours of the infection. Furthermore, the latter generation cephalosporins, including ceftriaxone, must be given consideration as antibiotics of first choice world wide.