[Rational bases of current etiopathogenetic therapy of bacterial meningitis. Review of the literature and personal experience in 122 pediatric cases].
Bacterial meningitis is a serious infectious disease, the course of which depends on the correct use of antibiotics and an intensive symptomatic and support therapy. The presence of microbes and their fractions in the CNS determines inflammatory phenomena that lead, through complex mechanisms, to the supportive treatment has the purpose of curbing the inflammatory phenomena, reducing cerebral oedema and avoiding ischaemia. This therapy makes use of cortisone and mannitol. The effectiveness of cortisone in reducing cerebral damage and, consequently, the neurological sequelae of the disease has been documented in experimental models and in man. After analysing the pathogenetic events of cerebral damage and the rationale of the treatment, reference is made to a personal therapeutic protocol that includes an aetiological treatment (Ceftriaxone 100 mg/kg/die), a support therapy (dexamethasone 0.2-0.3 mg/kg/die, mannitol, water restriction) and a symptomatic therapy (for convulsions, high temperature and shock). Both the antibiotic and cortisone are also introduced into the spine on the occasion of lumbar injection. 122 children suffering from non-tubercular bacterial meningitis, admitted to the Emergency Department of the Regina Margherita Infant Hospital of Turin in the period 1984-89, were treated. A further 7 patients, admitted for the same pathology, died within a few hours. In 88% of cases, aetiological agents were found by bacterioscopic and/or cultural and/or co-agglutinin on liquor examination (Neisseria meningitidis 47.5%, Haemophilus influenzae 20.5%, Streptococcus pneumoniae 15.6%, others 4.1%). The patients were treated with support therapy for as long as clinical conditions required it and with Ceftriaxone until clinical cure, end of fever and normalisation of PRC. In the reported series, 90% of patients were treated for from 3 to 6 days. This duration of antibiotic therapy is shorter than that reported and recommended in the literature. Therapeutic results were very good with 95% cure without neurological sequelae even at 6 month/1 year follow-up. Only 6 patients reported sequelae (2 irritative anomalies at EEG, 3 hypoacusis, 12 psychomotor retardation). The results were also better than those reported in the Italian and foreign literature. The Authors are convinced that, in the hands of experienced physicians, timely antibiotic, anti-inflammatory, cerebral anti-oedema and symptomatic treatment will improve the prognosis for bacterial meningitis in infancy.
Pecco
P
P
Servizio di Accettazione, Ospedale Infantile Regina Margherita, Torino.
Pavesio
D
D
Peisino
M G
MG
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001921:Brain / Q000503:physiopathology; D002443:Ceftriaxone / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003348:Cortisone / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004569:Electroencephalography; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008353:Mannitol / Q000627:therapeutic use; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D011379:Prognosis
D000900:Anti-Bacterial Agents; D008353:Mannitol; D002443:Ceftriaxone; D003907:Dexamethasone; D003348:Cortisone
Basi razionali della moderna terapia eziopatogenetica della meningite batterica. Revisione della letteratura ed esperienza personale su 122 casi pediatrici.