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Infection

, Volume 12, Supplement 1, pp S44–S48 | Cite as

Recent advances in management of bacterial meningitis in neonates

  • J. O. Klein
Workshop On Problems Of Bacterial Meningitis

Summary

The current incidence of neonatal sepsis in the United States varies from less than 1 to 8.1 per 1000 live births. The incidence of bacterial meningitis is about one-third of the number of infants with sepsis. The mortality is 20 to 30% and many survivors are severely impaired. Group B streptococcus andEscherichia coli are the most frequent causes of meningitis. Because of the difficulty of clinical diagnosis, many infants receive presumptive therapy for suspected sepsis or meningitis although few have documented infection. Between 5 and 10% of newborn infants born in the United States receive antimicrobial agents in the nursery, usually a penicillin and an aminoglycoside. To lower the continued high mortality and morbidity of meningitis due to gram-negative enteric bacilli, collaborative randomized trials evaluated the efficacy of gentamicin administered via the intrathecal route, gentamicin administered into the ventricle and most recently, the efficacy of moxalactam. Neither intrathecal or intraventricular drug, both in combination with parenteral drug, was advantageous when compared with parenterally administered drug alone. The mortality rate and number of days of culture positive cerebrospinal fluid were similar in infants who received moxalactam and ampicillin and infants who received amikacin and ampicillin. Adjunctive therapies including granulocyte transfusion, administration of hyperimmune gamma globulin and exchange transfusion are now under investigation. Initial studies of prevention of systemic bacterial infection by prophylactic ampicillin administered to the mother at delivery and use of group B streptococcal vaccine administered to susceptible women in the child bearing age show promise.

Keywords

Meningitis Amikacin Bacterial Meningitis Neonatal Sepsis Moxalactam 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Neuere Fortschritte in der Behandlung der bakteriellen Meningitis bei Neugeborenen

Zusammenfassung

Die Inzidenz der Neugeborenensepsis liegt in den Vereinigten Staaten derzeit zwischen weniger als 1 und 8,1 auf 1000 Lebendgeburten. Die Inzidenz an bakterieller Meningitis beträgt etwa ein Drittel der Anzahl der Kinder mit Sepsis. 20 bis 30% der Betroffenen sterben, und viele der Überlebenden tragen schwere Behinderungen davon. Die häufgsten Erreger der Meningitis sind Streptokokken der Gruppe B undEscherichia coli. Da die klinische Diagnose große Schwierigkeiten macht, werden viele Säuglinge wegen Verdachts auf Sepsis oder Meningitis vorsorglich behandelt, wenngleich nur bei wenigen eine nachgewiesene Infektion vorliegt. 5 bis 10% der in den Vereinigten Staaten geborenen Kinder erhalten in der Säuglingsstation antimikrobielle Substanzen, in der Regel ein Penicillin und ein Aminoglykosid. Um Wege zur Verminderung der anhaltend hohen Letalität und Morbidität der Meningitis durch gramnegative Enterobakterien zu finden, wurden kooperative randomisierte Studien durchgeführt, die die Wirksamkeit der intrathekalen und intraventrikulären Applikation von Gentamicin und erst kürzlich die Wirksamkeit von Moxalactam prüften. Weder die intrathekale noch die intraventrikuläre Applikationsform (beide in Kombination mit parenteralen Medikamenten) zeigten gegenüber der alleinigen parenteralen Arzneimittelgabe Vorteile. Die Letalität und die Anzahl der Tage mit positiven Liquorkulturen waren bei Säuglingen, die Moxalactam und Ampicillin erhielten, und bei Säuglingen, die mit Amikacin und Ampicillin behandelt wurden, ähnlich. Therapeutische Zusatzmaßnahmen einschließlich Granulozytentransfusion, Gabe von Hyperimmunglobulin und Austauschtransfusion werden derzeit geprüft. Erste Studien zur Verhütung systemischer bakterieller Infektionen durch prophylaktische Verabreichung von Ampicillin an die Mutter während der Entbindung und die Impfung von empfänglichen Frauen im gebärfähigen Alter mit einer Vakzine gegen Streptokokken der Gruppe B sind erfolgversprechend.

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Copyright information

© MMV Medizin Verlag GmbH München 1984

Authors and Affiliations

  • J. O. Klein
    • 1
  1. 1.Maxwell Finland Laboratory for Infectious DiseasesBoston City HospitalBostonU.S.A.

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