Salmonella meningitis in Thai infants: clinical case reports

Between June 1988 and September 1996 12 of 65 infants (18%) admitted to the Department of Pediatrics, Ramathibodi Hospital, Bangkok, Thailand with purulent meningitis were infected with Salmonella spp. Their ages ranged from 1.5 to 6 months. Six of the infants had diarrhoea, 9 had seizures, and 11 had subdural effusion or empyema. Six infants required surgical treatment; 2 had brain abscesses. Salmonella was recovered from the cerebrospinal fluid of 11 infants and from the subdural fluid of 10. Eight infants were successfully treated with cefotaxime alone or in combination with co-trimoxazole, one with co-trimoxazole, and one with the combination of co-trimoxazole and ampicillin. The duration of treatment was 6 weeks, except for one patient who had a large brain abscess and was treated for 8 weeks. The last 2 patients, despite the fact that the organisms were susceptible to cefotaxime, failed to respond clinically to appropriate doses of it. Both were cured after ciprofloxacin was added to the therapy. Ciprofloxacin is probably the drug of choice to be used in addition to the previously used antibiotics for severe cases of Salmonella meningitis in infants.