, Volume 65, Issue 8, pp 1097–1112 | Cite as

Bacterial Meningitis in Children

Critical Review of Current Concepts
Review Article


Acute bacterial meningitis is still an important cause of morbidity and mortality in children worldwide. Recently, Haemophilus influenzae type b (Hib), once a common cause of meningitis, has virtually disappeared in developed nations, reflecting the overwhelming success of Hib vaccination. Unfortunately, Hib remains a significant pathogen in resource-poor countries. The introduction of the conjugated pneumococcal vaccine in 2000 may lead to similar future trends as witnessed with Hib. As the resistance of Streptococcus pneumoniae to penicillin and cephalosporins continues to evolve, vancomycin has become an important antibacterial in the treatment of bacterial meningitis. The unreliable penetration of this agent into cerebrospinal fluid is of concern, which is compounded by the controversial use of corticosteroids in paediatric meningitis. Some data suggest that in certain situations the addition of rifampicin (rifampin) to ceftriaxone may be a better choice. While dexamethasone is now considered the standard adjunctive therapy in the treatment of pneumococcal meningitis in adult patients, the benefit in children is not so clear and remains controversial; thus, there is no definitive paediatric recommendation. Several anti-inflammatory agents currently under investigation may be used in the future as adjunctive therapy for bacterial meningitis.

It is clear that the current concepts in the treatment of childhood bacterial eningitis are evolving, and other antibacterial options and possible alternatives such as carbapenems and fluoroquinolones should be considered. Fluid restriction because of the Syndrome of Inappropriate Antidiuretic Hormone Secretion is widely advocated and used. Yet, this practice was recently challenged. It seems that most patients with meningitis do not need fluid restriction. The overwhelming success of the conjugated Hib vaccine and the encouraging results of the new conjugated pneumococcal and meningococcal vaccines suggest that the ideal management of bacterial meningitis is prevention and vaccines development against the most common bacterial agents are the best solution.



The authors would like to thank Dr Stanford T. Shulman for his helpful comments and Sara Calvert for her secretarial assistance.

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest directly relevant to the content of this review.


  1. 1.
    Wenger JD, Hightower AW, Facklam RR, et al. Bacterial meningitis in the United States, 1986: report of a multistate surveillance study. J Infect Dis 1990; 162: 1316–23PubMedGoogle Scholar
  2. 2.
    Short WR, Tunkel AR. Changing epidemiology of bacterial meningitis in the United States. Curr Infect Dis Rep 2000; 2: 327–31PubMedGoogle Scholar
  3. 3.
    Koedel U, Scheid WM, Pfister HW. Pathogenesis and pathophysiology of pneumococcal meningitis. Lancet Infect Dis 2002; 2: 721–36PubMedGoogle Scholar
  4. 4.
    Hansman D, Bullen MM. A resistant pneumococcus. Lancet 1967; 1: 264–5Google Scholar
  5. 5.
    Whitney CG, Farley MM, Hadler M, et al. Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. N Engl J Med 2000; 343: 1917–24PubMedGoogle Scholar
  6. 6.
    Hoban DJ, Doern GV, Fluit AC, et al. Worldwide prevalence of antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the SENTRY Antimicrobial Surveillance Program, 1997–1999. Clin Infect Dis 2001; 32 Suppl. 2: S81–93PubMedGoogle Scholar
  7. 7.
    Feigin, RD, Pearlman E. Bacterial meningitis beyond the neonatal period. In: Feigin RD, Cherry JO, Demmber GJ, et al., editors. Textbook of pediatric infectious diseases. 5th ed. Philadelphia (PA): Saunders, 2003: 443–74Google Scholar
  8. 8.
    De Gans J, Van de Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002; 347: 1549–56PubMedGoogle Scholar
  9. 9.
    Centers for Disease Control and Prevention. Progress towards eliminating Haemophilus influenzae type b disease among infants and children: United States, 1987–1997. MMWR Morb Mortal Wkly Rep 1998; 47(46): 993–8Google Scholar
  10. 10.
    Schuchat A, Robinson K, Wenger JD, et al. Bacterial meningitis in the United States in1995. N Engl J Med 1997; 337: 970–6PubMedGoogle Scholar
  11. 11.
    Whitney CG, Farley MM, Hadler JH, et al. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 2003; 348: 1737–46PubMedGoogle Scholar
  12. 12.
    Kaplan SL, Mason EO, Wald ER, et al. Decrease of invasive pneumococcal infections in children among 8 children’s hospitals in the United States after the introduction of the 7-valent pneumococcal conjugate vaccine. Pediatrics 2004; 113: 443–9PubMedGoogle Scholar
  13. 13.
    Pastor P, Medley KB, Murphy TV. Meningococcal disease in Dallas County, Texas: results of a six-year population-based study. Pediatr Infect Dis J 2000; 19: 324–48PubMedGoogle Scholar
  14. 14.
    Rosenstein N, Perkins B, Stephens D, et al. The changing epidemiology of meningococcal disease in the United States, 1992–1996. J Infect Dis 1999; 180: 1894–901PubMedGoogle Scholar
  15. 15.
    Scholten R, Bijlmer H, Valkenburg H, et al. Patient and strain characteristics in relation to the outcome of meningococcal disease: a multivariate analysis. Epidemiol Infect 1994; 112: 115–9PubMedGoogle Scholar
  16. 16.
    Balmer P, Borrow R, Miller E. Impact of meningococcal C conjugate vaccine in the UK. J Med Microbiol 2002; 51: 717–22PubMedGoogle Scholar
  17. 17.
    Emele FE. Etiologic spectrum and pattern of antimicrobial drug susceptibility in bacterial meningitis in Sokoto, Nigeria. Acta Paediatr 2000; 89: 942–6PubMedGoogle Scholar
  18. 18.
    World Health Organization. Epidemic meningococcal disease. WHO Fact Sheet105. Geneva: WHO, 1998Google Scholar
  19. 19.
    Tauber MG, Doroshow CA, Hackbarth CJ, et al. Antibacterial activity of β-lactam antibiotics in experimental meningitis due to Streptococcus pneumoniae. J Infect Dis 1984; 149: 568–74PubMedGoogle Scholar
  20. 20.
    Scheid WM, Brown RS, Sande MA. Comparison of netilmicin and gentamicin in the therapy of experimental Escherichia coli meningitis. Antimicrob Agents Chemother 1978; 13: 899–904Google Scholar
  21. 21.
    Kim YS, Liou Q, Chow LL, et al. Trovafloxacin in treatment of rabbits with experimental meningitis caused by high-level penicillin-resistant Streptococcus pneumoniae. Antimicrob Agents Chemother 1997; 41: 1186–9PubMedGoogle Scholar
  22. 22.
    Nau R, Schmidt T, Kaye K, et al. Quinolone antibiotics in therapy of experimental pneumococcal meningitis in rabbits. Antimicrob Agents Chemother 1995; 39: 593–7PubMedGoogle Scholar
  23. 23.
    Lutsar I, McCracken GH, Friedland IR, et al. Antibiotic pharmacodynamics in cerebrospinal fluid. Clin Infect Dis 1998; 27: 1117–29PubMedGoogle Scholar
  24. 24.
    Nau R, Kaye K, Sachdeva M, et al. Rifampin for therapy of experimental pneumococcal meningitis in rabbits. Antimicrob Agents Chemother 1994; 38: 1186–9PubMedGoogle Scholar
  25. 25.
    Quagliarello VJ, Long WJ, Scheid WM. Morphologic alterations of the blood-brain barrier with experimental meningitis in the rat. J Clin Invest 1986; 77: 1084–95PubMedGoogle Scholar
  26. 26.
    Hieber JP, Nelson JD. A pharmacologic evaluation of penicillin in children with purulent meningitis. N Engl J Med 1977; 297: 410–3PubMedGoogle Scholar
  27. 27.
    Chowdhury MH, Tunkel AR. Antibacterial agents in infections of the central nervous system. Infect Dis Clin N Am 2000; 14: 391–408Google Scholar
  28. 28.
    Krontz DP, Strausbaugh LJ. Effect of meningitis and probenecid on the penetration of vancomycin into cerebrospinal fluid in rabbits. Antimicrob Agents Chemother 1980; 18: 882–6PubMedGoogle Scholar
  29. 29.
    Spector R, Lorenzo AV. Inhibition of penicillin transport from the CSF following intracisternal inoculation of bacteria. J Clin Invest 1974; 54: 316–25PubMedGoogle Scholar
  30. 30.
    Craig WA. Pharmacokinetic/pharmacodynamic parameters: rationale for antibacterial dosing of mice and men. Clin Infect Dis 1998; 26: 1–12PubMedGoogle Scholar
  31. 31.
    Aronin SI, Peduzzi P, Quagliarello VJ. Community-acquired bacterial meningitis: risk stratification for adverse clinical outcome and effect of antibiotic timing. Ann Intern Med 1998; 129: 862–9PubMedGoogle Scholar
  32. 32.
    Radetsky M. Duration of symptoms and outcome in bacterial meningitis: an analysis of causation and the implications of a delay in diagnosis. Pediatr Infect Dis J 1992; 11: 694–8PubMedGoogle Scholar
  33. 33.
    American Academy of Pediatrics. Pneumococcal infections. In: Pickering LK, editor. Red book: 2003 report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village (IL): American Academy of Pediatrics, 2003: 490–500Google Scholar
  34. 34.
    Arditi M, Mason EO, Bradley JS, et al. Three-year multicenter surveillance of pneumococcal meningitis in children: clinical characteristics, and outcome related to penicillin susceptibility and dexamethasone use. Pediatrics 1998; 102: 1087–97PubMedGoogle Scholar
  35. 35.
    Friedland IR, Paris M, Ehrett S, et al. Evaluation of antimicrobial regimens for treatment of experimental penicillin- and cephalosporin-resistant pneumococcal meningitis. Antimicrob Agents Chemother 1993; 37: 1630–6PubMedGoogle Scholar
  36. 36.
    Klugman KP, Friedland IR, Bradley JS. Bactericidal activity against cephalosporin-resistant Streptococcus pneumoniae in cerebrospinal fluid of children with acute bacterial meningitis. Antimicrob Agents Chemother 1995; 39: 1988–92PubMedGoogle Scholar
  37. 37.
    National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing. 13th Informational Supplement (Aerobic Dilution). Wayne (PA): National Committee for Clinical Laboratory Standards, 2003: 44–6Google Scholar
  38. 38.
    Viladrich PF, Gudiol F, Linares J, et al. Evaluation of vancomycin for therapy of adult pneumococcal meningitis. Antimicrob Agents Chemother 1991; 35: 2467–72PubMedGoogle Scholar
  39. 39.
    Schaad UB, Suter S, Gianella-Borradori A, et al. A comparison of ceftriaxone and cefuroxime for the treatment of bacterial meningitis in children. N Engl J Med 1990; 322: 141–7PubMedGoogle Scholar
  40. 40.
    Paris MM, Hickey SM, Uscher MI, et al. Effect of dexamethasone on therapy of experimental penicillin- and cephalosporin-resistant pneumococcal meningitis. Antimicrob Agents Chemother 1994; 38: 1320–4PubMedGoogle Scholar
  41. 41.
    Novak R, Henriques B, Charpentier E, et al. Emergence of vancomycin tolerance in Streptococcus pneumoniae. Nature 1999; 399: 590–3PubMedGoogle Scholar
  42. 42.
    Nau R, Wellmer A, Soto A, et al. Rifampin reduces early mortality in experimental Streptococcus pneumoniae meningitis. J Infect Dis 1999; 179: 1557–60PubMedGoogle Scholar
  43. 43.
    Gerber J, Yamini P, Nau R. After pretreatment by rifampin, ceftriaxone releases smaller quantities of lipoteichoic and teichoic acids (LTA/TA) from Streptococcus pneumoniae than ceftriaxone alone [abstract no. 1788]. 39th Interscience Conference on Antimicrobial Agents and Chemotherapy; 1992 Sep 26–29; San FranciscoGoogle Scholar
  44. 44.
    Odio CM, Puig JR, Feris JM, et al. Prospective, randomized, investigator-blinded study of the efficacy and safety of meropenem vs cefotaxime therapy in bacterial meningitis in children. Pediatr Infect Dis J 1999; 18: 581–90PubMedGoogle Scholar
  45. 45.
    Thornsberry C, Ogilvie P, Holley HP, et al. The activity of fluoroquinolones and other antimicrobial agents against Streptococcus pneumoniae, Haemophilius influenzae, and Moraxella catarrhalis. Drugs 1999; 58 Suppl. 2: 346–8Google Scholar
  46. 46.
    Tarasi A, Capone A, Tarasi D, et al. Comparative in-vitro activity of maxifloxacin, penicillin, ceftriaxone, and ciprofloxacin against pneumococci isolated from meningitis. J Antimicrob Chemother 1999; 43: 833–5PubMedGoogle Scholar
  47. 47.
    Smirnov A, Welmer A, Gerber J, et al. Gemifloxacin is effective in experimental pneumonococcal meningitis. Antimicrob Agents Chemother 2000; 44: 767–70PubMedGoogle Scholar
  48. 48.
    Lutsar I, Friedland IR, Wubbel L, et al. Pharmacodynamics of gatifloxacin in cerebrospinal fluid in experimental cephalosporin-resistant pneumococcal meningitis. Antimicrob Agents Chemother 1998; 42: 2650–5PubMedGoogle Scholar
  49. 49.
    Filka J, Uher J, Kurak H, et al. Ciprofloxacin in the treatment of nosocomial meningitis in neonates and infants. Drugs 1999; 58 Suppl. 2: 263–5Google Scholar
  50. 50.
    Saez-Llorens X, McCoig C, Feris JM, et al. Quinolone treatment for pediatric bacterial meningitis: a comparative study of trovafloxacin and ceftriaxone with or without vancomycin. Pediatr Infect Dis J 2002; 21: 14–22PubMedGoogle Scholar
  51. 51.
    Ho PL, Que TL, Tsang DN, et al. Emergence of fluoroquinolone resistance among multiple resistant strains of Streptococcus pneumoniae in Hong Kong. Antimicrob Agents Chemother 1999; 43: 1310–3PubMedGoogle Scholar
  52. 52.
    Chen DK, McGeer A, de Azavedo JC, et al. Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. N Engl J Med 1999; 341: 233–9PubMedGoogle Scholar
  53. 53.
    Yogev R, Edge-Padbury B, Naberhuis-Stehouwer S, et al. Linezolid vs vancomycin in children with complicated skin/ skin structure infections: the Linezolid Pediatric Study Group [poster no. 1839]. Pediatric Academic Societies’ Meeting (PAS); 2003 May 3–6; SeattleGoogle Scholar
  54. 54.
    Zeana C, Kublin CJ, Della-Latta P, et al. Vancomycin-resistant Enterococcus faecium meningitis successfully managed with linezolid: case report and review of the literature. Clin Infect Dis 2001; 33: 477–82PubMedGoogle Scholar
  55. 55.
    Shaikh ZH, Peloquin CA, Ericcson CD. Successful treatment of vancomycin-resistant Enterococcus faecium meningitis with linezolid: case report and review of the literature. Scand J Infect Dis 2001; 33: 375–9PubMedGoogle Scholar
  56. 56.
    Cottagnoud P, Gerber CM, Acosta F, et al. Linezolid against penicillin-sensitive and -resistant pneumococci in the rabbit model. J Antimicrob Chemother 2000; 46: 981–5PubMedGoogle Scholar
  57. 57.
    Lee H, Park J, Jang SE. High incidence of resistance to multiply antimicrobials in clinical isolates of Streptococcus pneumoniae from a university hospital in Korea. Clin Infect Dis 1995; 20: 826–35PubMedGoogle Scholar
  58. 58.
    Friedland IR, Klugman KP. Failure of chloramphenicol therapy in penicillin-resistant pneumococcal meningitis. Lancet 1992; 339: 405–8PubMedGoogle Scholar
  59. 59.
    Sande MA, Korzeniowski OM, Allegro GM. Intermittent or continuous therapy of experimental meningitis due to Streptococcus pneumoniae in rabbits: preliminary observations on the postantibiotic effect in vivo. Rev Infect Dis 1981; 3: 98–109PubMedGoogle Scholar
  60. 60.
    Roine I, Ledermann W, Foncea LM. Randomized trial of four vs seven days of ceftriaxone treatment for bacterial meningitis in children with rapid initial recovery. Pediatr Infect Dis J 2000; 19: 219–22PubMedGoogle Scholar
  61. 61.
    Campos J, Garcia-Tornel S, Gairi JM, et al. Multiply resistant Haemophilus influenzae type b causing meningitis: comparative clinical and laboratory study. J Pediatr 1986; 108: 897–902PubMedGoogle Scholar
  62. 62.
    Givner LB, Abramson JS, Wasilauskas B. Meningitis due to Haemophilus influenzae type b resistant to ampicillin and chloramphenicol. Rev Infect Dis 1989; 11: 329–34PubMedGoogle Scholar
  63. 63.
    Peltola J, Anttila M, Renkonen OV, et al. Randomized comparison of chloramphenicol, ampicillin, cefotaxime, and ceftriaxone for childhood bacterial meningitis. Lancet 1989; I: 1281–7Google Scholar
  64. 64.
    Lebel MH, McCracken Jr GH. Delayed cerebrospinal fluid sterilization and adverse outcome of bacterial meningitis in infants and children. Pediatrics 1989; 83: 161–7PubMedGoogle Scholar
  65. 65.
    Saez-Llorens X, Castano E, Garcia R, et al. Prospective randomized comparison of cefepime and cefotaxime for treatment of bacterial meningitis in infants and children. Antimicrob Agents Chemother 1995; 39: 937–40PubMedGoogle Scholar
  66. 66.
    American Academy of Pediatrics. Haemophilus influenzae infections. In: Pickering LK, editor. Red Book: 2003 report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village (IL): American Academy of Pediatrics, 2003: 293–301Google Scholar
  67. 67.
    Lin TY, Chrane DF, Nelson JD, et al. Seven days of ceftriaxone therapy is as effective as ten days’ treatment for bacterial meningitis. JAMA 1985; 253: 3559–63PubMedGoogle Scholar
  68. 68.
    Saez-Nieto JA, Lujan R, Berron S, et al. Epidemiology and molecular basis of penicillin-resistant Neisseria meningitidis in Spain: a 5-year history (1985–89). Clin Infect Dis 1992; 14: 394–402PubMedGoogle Scholar
  69. 69.
    Klugman KP, Madhi SA. Emergence of drug resistance: impact on bacterial meningitis. Infect Dis Clin North Am 1999; 13: 637–46PubMedGoogle Scholar
  70. 70.
    Woods CR, Smith AL, Wasilauskas BL, et al. Invasive disease caused by Neisseria meningitidis relatively resistant to penicillin in North Carolina. J Infect Dis 1994; 170: 453–6PubMedGoogle Scholar
  71. 71.
    American Academy of Pediatrics. Meningococcal infections. In: Pickering LK, editor. Red book: 2003 report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village (IL): American Academy of Pediatrics, 2003: 430–6Google Scholar
  72. 72.
    Luaces Cubells C, Garcia Garcia JJ, Roca Martinez J, et al. Clinical data in children with meningococcal meningitis in a Spanish hospital. Acta Paediatr 1997; 86: 26–9PubMedGoogle Scholar
  73. 73.
    Galimand M, Gerbaud G, Guibourdenche M, et al. High-level chloramphenicol resistance in Neisseria meningitidis. N Engl J Med 1998; 339: 868–74PubMedGoogle Scholar
  74. 74.
    Macfarlane JT, Anjorin FI, Cleland PG, et al. Single injection treatment of meningococcal meningitis. 1: long-acting penicillin. Trans R Soc Trop Med Hyg 1979; 73: 693–7Google Scholar
  75. 75.
    Wali SS, Macfarlane JT, Weir WRC, et al. Single injection treatment of meningococcal meningitis. 2: long-acting chloramphenicol. Trans R Soc Trop Med Hyg 1979; 73: 698–702Google Scholar
  76. 76.
    Viladrich PF, Pallares R, Ariza J, et al. Four days of penicillin therapy for meningococcal meningitis. Arch Intern Med 1986; 146: 2380–2PubMedGoogle Scholar
  77. 77.
    O’Neill P. How long to treat bacterial meningitis. Lancet 1993; 341: 530–2PubMedGoogle Scholar
  78. 78.
    McIntyre PB, Berkey CS, King SM, et al. Dexamethasone as adjunctive therapy in bacterial meningitis: a meta-analysis of randomized clinical trials since1988. JAMA 1997; 278: 925–31PubMedGoogle Scholar
  79. 79.
    Girgis NI, Farid Z, Mikhail IA, et al. Dexamethasone treatment for bacterial meningitis in children and adults. Pediatr Infect Dis 1989; 8: 848–51Google Scholar
  80. 80.
    Kanra GY, Ozen H, Secmeer G, et al. Beneficial effects of dexamethasone in children with pneumococcal meningitis. Pediatr Infect Dis J 1995; 14: 490–4PubMedGoogle Scholar
  81. 81.
    Kennedy WA, Hoyt MJ, McCracken GH. The role of corticosteroid therapy in children with pneumococcal meningitis. Am J Dis Child 1991; 145: 1374–8PubMedGoogle Scholar
  82. 82.
    Cabellos C, Martinez-Lacasa J, Martos A, et al. Influence of dexamethasone on efficacy of ceftriaxone and vancomycin therapy in experimental pneumococcal meningitis. Antimicrob Agents Chemother 1995; 39: 2158–60PubMedGoogle Scholar
  83. 83.
    Quagliarello VJ, Scheld WM. Treatment of bacterial meningitis. N Engl J Med 1997; 336: 708–16PubMedGoogle Scholar
  84. 84.
    Kastenbauer S, Pfister HW. Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain 2003; 126: 1015–25PubMedGoogle Scholar
  85. 85.
    Molyneux EM, Walsh AL, Forsyth H, et al. Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomized controlled trial. Lancet 2002; 360: 211–8PubMedGoogle Scholar
  86. 86.
    Zysk G, Bruck W, Gerber J, et al. Anti-inflammatory treatment influences neuronal apoptotic cell death in the dentate gyrus in experimental pneumococcal meningitis. J Neuropathol Exp Neurol 1996; 55: 722–8PubMedGoogle Scholar
  87. 87.
    Leib SL, Heimgartner C, Bifrafe YD, et al. Dexamethasone aggravates hippocampal apoptosis and learning deficiency in pneumococcal meningitis in infant rats. Pediatr Res 2003; 54: 353–7PubMedGoogle Scholar
  88. 88.
    Rappaport JM, Bhatt SM, Burkard RF, et al. Prevention of hearing loss in experimental pneumococcal meningitis by the administration of dexamethasone and ketorolac. J Infect Dis 1999; 179: 264–8PubMedGoogle Scholar
  89. 89.
    Park WS, Chang YS, Ko SY, et al. Efficacy of anti-tumor necrosis factor-alpha antibody as an adjunctive therapy in experimental Escherichia coli meningitis in the newborn piglet. Biol Neonate 1999; 75: 377–87PubMedGoogle Scholar
  90. 90.
    Alavi A, Shoa L, Lattanand C, et al. Brain tumor permeability enhanced by RMP-7, a novel bradykinin agonist. Can J Infect Dis 1995; 6 Suppl. C: 4153–7Google Scholar
  91. 91.
    Irazuzta JE, Pretzlaff R, Rowin M, et al. Hypothermia as an adjunctive treatment for severe bacterial meningitis. Brain Res 2000; 881: 88–97PubMedGoogle Scholar
  92. 92.
    Kaplan SL, Feigin RD. The syndrome of inappropriate secretion of antidiuretic hormone in children with bacterial meningitis. J Pediatr 1978; 92: 758–61PubMedGoogle Scholar
  93. 93.
    Duke T, Molyneux EL. Intravenous fluids for seriously ill children: time to reconsider. Lancet 2003; 362: 1320–3PubMedGoogle Scholar
  94. 94.
    Kanakriyeh M, Carvajal HF, Vallone AM. Initial fluid therapy for children with meningitis with consideration of syndrome of inappropriate antidiuretic hormone. Clin Pediatr 1987; 26: 126–30Google Scholar
  95. 95.
    Powell KR, Sugarman LI, Eskenazi AE, et al. Normalization of plasma arginine vasopressin concentrations when children with meningitis are given maintenance plus replacement fluid therapy. J Pediatr 1990; 117: 515–22PubMedGoogle Scholar
  96. 96.
    Singhi SC, Singhi PD, Srinivas B, et al. Fluid restriction does not improve the outcome of acute meningitis. Pediatr Infect Dis J 1995; 14: 495–503PubMedGoogle Scholar
  97. 97.
    Bartter FC, Schwartz WB. The syndrome of inappropriate secretion of antidiuretic hormone. Am J Med 1967; 42: 790–806PubMedGoogle Scholar
  98. 98.
    Stanwell-Smith RE, Stuart JM, Hughes AO, et al. Smoking, the environment, and meningococcal disease: a case control study. Epidemiol Infect 1994; 112: 315–28PubMedGoogle Scholar
  99. 99.
    Almog R, Block C, Gdalevitch M, et al. First recorded outbreak of meningococcal disease in the Israel Defence Force: three clusters due to serotype C and the emergence of resistance to rifampicin. Infection 1994; 22: 67–71Google Scholar
  100. 100.
    Abadi FJ, Carter PE, Cash P, et al. Rifampicin resistance in Neisseria meningitidis due to alterations in membrane permeability. Antimicrob Agents Chemother 1996; 40: 646–51PubMedGoogle Scholar
  101. 101.
    Osterholm MT, Murphy TD. Does rifampin prophylaxis prevent disease caused by Haemophilus influenzae type b? JAMA 1984; 251: 2408–9PubMedGoogle Scholar
  102. 102.
    Mann M, Hull HF. New Haemophilus influenzae type b control strategy: premature commitment to prophylaxis? Pediatrics 1983; 72: 118–21PubMedGoogle Scholar
  103. 103.
    Shapiro ED, Wald ER. Efficacy of rifampin in eliminating pharyngeal carriage of Haemophilus influenzae type b. Pediatrics 1980; 66: 5–8PubMedGoogle Scholar
  104. 104.
    Foster C, Nadel S. New therapies and vaccines for bacterial meningitis. Expert Opin Investig Drugs 2002; 11: 1051–60PubMedGoogle Scholar
  105. 105.
    Lennon D, Gellin B, Hood D, et al. Successful intervention in group A meningococcal outbreak in Auckland, New Zealand. Pediatr Infect Dis J 1992; 11: 617–23PubMedGoogle Scholar
  106. 106.
    Ramsey ME, Andrews N, Kaczmarski EB, et al. Efficacy of meningococcal serogroup C conjugate vaccine in teenagers and toddlers in England. Lancet 2001; 357: 195–6Google Scholar
  107. 107.
    Ramsay ME, Andrews NJ, Trotter CL, et al. Herd immunity from meningococcal serogroup C conjugate vaccination in England: database analysis. BMJ 2003; 326: 365–6PubMedGoogle Scholar
  108. 108.
    Haneberg B, Dalseg R, Wedege E, et al. Intranasal administration of a meningococcal outer membrane vesicle vaccine induces persistent local mucosal antibodies and serum antibodies with strong bactericidal activity in humans. Infect Immun 1998; 66: 1334–41PubMedGoogle Scholar
  109. 109.
    Sierra GV, Campa HC, Varcacel NM, et al. Vaccine against group B Neisseria meningitidis: protection trial and mass vaccination results in Cuba. NIPH Ann 1991; 14: 195–210PubMedGoogle Scholar
  110. 110.
    Bjune G, Høiby EA, Grønnesby JK, et al. Effect of outer membrane vesicle vaccine against group B meningococcal disease in Norway. Lancet 1991; 338: 1093–6PubMedGoogle Scholar
  111. 111.
    O’Hallahan J, Lennon D, Oster P. The strategy to control New Zealand’s epidemic of group B meningococcal disease. Ped Infect Dis J 2004; 23 Suppl. 12: S293–8Google Scholar
  112. 112.
    Fucso PC, Michon F, Tai JY, et al. Preclinical evaluation of a novel group B meningococcal conjugate vaccine that elicits bactericidal activity in both mice and nonhuman primates. J Infect Dis 1997; 175: 364–72Google Scholar
  113. 113.
    Memish A. Meingococcal disease and travel. Clin Infect Dis 2002; 34: 84–90PubMedGoogle Scholar
  114. 114.
    Control and prevention of serogroup C meningococcal disease: evaluation and management of suspected outbreaks. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1997; 46(RR-5): 13–21Google Scholar

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© Adis Data Information BV 2005

Authors and Affiliations

  1. 1.Feinberg School of MedicineChildren’s Memorial HospitalChicagoUSA

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