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Five days of antibacterial therapy for bacterial meningitis in children?

5-Tages-Therapie für die antimikrobielle Behandlung der bakteriellen Meningitis im Kindesalter?

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Summary

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) forHaemophilus influenzae b meningitis. On day 5 of therapy the activity of aspartate aminotransferase (AST), lactic dehydrogenase (LDH), creatine phosphokinase (CPK) and gamma-glutamyl-transpeptidase (γGT) 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 γGT 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. Long term follow-up did not differ between the two groups. We conclude that 5 days of antibacterial therapy is adequate for the treatment of meningococcal meningitis in children.

Zusammenfassung

Die Wirksamkeit einer 5tägigen antibakteriellen Therapie wurde bei bakterieller Meningitis im Kindesalter geprüft. Die Studiengruppe umfaßte 26 Kinder im Alter von 2 Monaten bis 15 Jahren, die 1990–1993 mit mikrobiologisch gesicherter bakterieller Meningitis aufgenommen und 5 Tage lang behandelt wurden. 49 Patienten, die 8–15 Tage lang behandelt wurden, dienten als historische Vergleichsgruppe. Bei Meningokokken- und Pneumokokken-Meningitis wurde eine Monotherapie mit Penicillin (300 mg/kg KG) durchgeführt, dieHaemophilus influenzae-Meningitis wurde mit Ampicillin (300 mg/kg KG) behandelt. Am Behandlungstag 5 wurden die Aktivitäten von Aspartataminotransferase (AST), Laktatdehydrogenase (LDH), Kreatinphosphokinase (CPK) und gamma-Glutamyl-Transpeptidase (γGT) im Liquor fotokolorimetrisch bestimmt. Die Kreatinkinase BB-Konzentration (CK-BB) wurde mittels ELISA gemessen. IL-6 wurde mit einer EIA Technik bestimmt und zum Zeitpunkt des Therapieendes mit Antibiotika wurde eine zerebrale Ultraschalluntersuchung vorgenommen. Die mittlere Verlaufsbeobachtung betrug bei den Kindern der Studiengruppe 1,3 Jahre, bei der Kontrollgruppe 3,2 Jahre. Kinder, die die 5-Tages-Therapie erhielten, blieben kürzer in stationärer Behandlung (p<0,005). Eine vollständige klinische Wiederherstellung war bei Kindern der Studiengruppe bei Therapieende in 81% und bei der Vergleichsgruppe in 66% der Fälle eingetreten. Rezidive ereigneten sich nicht. Am 5. Therapietag hatten sich AST, CPK, LDH und γGT im Liquor normalisiert, die Konzentration von CK-BB war noch fast 7fach erhöht. Die IL-6 Konzentration im Liquor nahm mit der Therapie von 1,800 pg/ml auf 685 pg/ml ab, blieb jedoch noch erhöht. Die Langzeit-Verlaufsbeobachtung zeigte keine Unterschiede zwischen den Gruppen. Wir folgern, daß eine antibakterielle 5-Tages-Therapie für die Behandlung der Meningokokkenmeningitis bei Kindern adäquat ist.

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Authors and Affiliations

  1. Tartu University Children's Hospital, Lunini 6, EE-2400, Tartu, Estonia

    I. Lutsar M. D., A. Gontmacher M. D., M. Närska M. D., V. Rüütel M. D., M. Topman M. D., P. Ilves M. D., T. Siirde M. D. & A. Beilmann M. D.

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  1. I. Lutsar M. D.
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  2. A. Gontmacher M. D.
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  3. M. Närska M. D.
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  4. V. Rüütel M. D.
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  5. M. Topman M. D.
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  6. P. Ilves M. D.
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  7. T. Siirde M. D.
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  8. A. Beilmann M. D.
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Lutsar, I., Gontmacher, A., Närska, M. et al. Five days of antibacterial therapy for bacterial meningitis in children?. Infection 23, 113–118 (1995). https://doi.org/10.1007/BF01833878

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