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Treatment of childhood bacterial meningitis

Behandlung der bakteriellen Meningitis im Kindesalter

  • Addendum I
  • Cefotaxime — Recent Experiences
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Summary

One hundred and eighty-seven children with identified bacterial meningitis were treated with intravenous cefotaxime: 15 patients were neonates, 79 infants, and 93 were aged from 1 to 14 years. Causative organisms were:Neisseria meningitidis in 80 cases,Streptococcus pneumoniae in 41,Haemophilus influenzae in 40, enteric gram-negative bacilli in 20 andStaphylococcus spp. in six. Enteric gram-negative bacilli included:Salmonella spp. in 14 cases,Klebsiella pneumoniae in two, andEscherichia coli, Enterobacter sakazakii andAcinobacter calcoaceticus in one each; in one case the organism was not specified. Daily dose of cefotaxime was 150 to 300 mg/kg. Concomitant treatment with an aminoglycoside was used in seven cases. One hundred and seventy-two patients (92.0%) were cured. Fever persisted for a mean of five days and meningeal signs for a mean of four days. Fifteen (8.0%) patients died: most [13] of them were admitted in coma, and two in shock. Death occurred in the first 48 h in ten cases. Sterilization of CSF was achieved in the first 72 h of treatment in 155 (90.1%) of the cured patients. Cefotaxime was well tolerated. CSF penetration of cefotaxime was evaluated in seven patients: concentrations ranged from 0.499 mg/l to 2.829 mg/l. Based on this clinical study, cefotaxime is an effective and safe drug for the treatment of childhood bacterial meningitis.

Zusammenfassung

187 Kinder mit bakterieller Meningitis gesicherter Atiologie wurden intravenös mit Cefotaxim behandelt. 15 der Patienten waren Neugeborene, 79 Säuglinge, und 93 waren im Alter von 1–14 Jahren. Als kausale Erreger wurden in 80 FällenNeisseria meningitidis, in 41Streptococcus pneumoniae, in 40Haemophilus influenzae, in 20 gramnegative Darmbakterien und in sechs FällenStaphylococcus spp. identifiziert. Unter den gramnegativen Darmbakterien fanden sichSalmonella spp. in 14,Klebsiella pneumoniae in zwei sowieEscherichia coli, Enterobacter sakazakii undAcinetobacter calcoaceticus in je einem Fall; in einem Fall gelang die Erregerspezifizierung nicht. Die tägliche Cefotaxim-Dosis lag zwischen 150 und 300 mg/kg. In sieben Fällen wurde eine Kombinationstherapie mit einem Aminoglykosid durchgeführt. Bei 172 Patienten trat eine Heilung ein (92,0%). Das Fieber hielt im Mittel fünf und die Meningitis-Zeichen vier Tage an. 15 Patienten verstarben, davon waren 13 im Koma und zwei im Schock eingeliefert worden. Zehn Kinder verstarben innerhalb der ersten 48 Stunden. Bei 155 (90,1%) der geheilten Patienten wurde der Liquor innerhalb der ersten 48 h nach Therapiebeginn steril. Die Verträglichkeit von Cefotaxim war gut. Bei sieben Patienten wurde die Liquorpenetration von Cefotaxim untersucht: Die Konzentrationen lagen zwischen 0,499 und 2,829 mg/l. Die Ergebnisse dieser Studie zeigen, daß Cefotaxim ein wirksames und sicheres Therapeutikum für die bakterielle Meningitis im Kindesalter ist.

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Authors and Affiliations

  1. Department of Infectious Diseases, School of Medicine, Hospital S. Joao, 4200, Porto, Portugal

    H. Lecour Ph.D., A. Seara M.D., J. Cordeiro M.D. & M. Miranda M.D.

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  1. H. Lecour Ph.D.
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  2. A. Seara M.D.
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  3. J. Cordeiro M.D.
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  4. M. Miranda M.D.
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Lecour, H., Seara, A., Cordeiro, J. et al. Treatment of childhood bacterial meningitis. Infection 17, 343–346 (1989). https://doi.org/10.1007/BF01650726

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