Five days of antibacterial therapy for bacterial meningitis in children?
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) for Haemophilus influenzae b meningitis. On day 5 of therapy the activity of aspartate aminotransferase (AST), lactic dehydrogenase (LDH), creatine phosphokinase (CPK) and gamma-glutamyl-transpeptidase (gamma GT) 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 gamma GT 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.(ABSTRACT TRUNCATED AT 250 WORDS)
Lutsar
I
I
Tartu University Children's Hospital, Estonia.
Gontmacher
A
A
Närska
M
M
Rüütel
V
V
Topman
M
M
Ilves
P
P
Siirde
T
T
Beilmann
A
A
D000293:Adolescent; D000667:Ampicillin / Q000627:therapeutic use*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D004569:Electroencephalography; D004798:Enzymes / Q000134:cerebrospinal fluid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015850:Interleukin-6 / Q000134:cerebrospinal fluid; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000150:complications / Q000188:drug therapy*; D008583:Meningitis, Haemophilus / Q000134:cerebrospinal fluid / Q000188:drug therapy; D008585:Meningitis, Meningococcal / Q000134:cerebrospinal fluid / Q000188:drug therapy; D008586:Meningitis, Pneumococcal / Q000134:cerebrospinal fluid / Q000188:drug therapy; D010406:Penicillins / Q000627:therapeutic use*; D013997:Time Factors; D014463:Ultrasonography
D004798:Enzymes; D015850:Interleukin-6; D010406:Penicillins; D000667:Ampicillin