[Suppurative meningitis in infants and in children: adjuvant treatments and treatments of neurological forms].
Systematic restricted fluid administration (800 to 1,000 ml/m2/day) as usually recommended at the initial phase of bacterial meningitis (BM) has been revisited. Fluid restriction is now only proposed when the evidence of ADH hypersecretion has been documented. A careful attention to this syndrome should be paid by close monitoring of diuresis, body weight, plasma electrolytes and urinary density. In the absence of patent ADH hypersecretion, normal fluid intake should be provided. Seizures occur in 20-30% of cases of BM. Isolated seizures can be treated with phenytoïne or phenobarbital, while active seizures must be treated with diazepam. A low incidence of seizures (13%) has been documented in one study using a preventive administration of barbiturates; however, this needs to be confirmed before in order to be recommended. The evolution of fever is a good index of the efficacy of the antibiotic treatment. In addition, fever has been demonstrated to decrease bacterial growth rate in experimental meningitis. Thus, the administration of antipyretic drugs should be limited to the cases with a fever higher than 39 degrees C. Neurologic forms include coma, seizures, motor deficits and neurovegetative disturbances. Intracranial hypertension due to cerebral oedema is the usual mechanism of these manifestations. Coning occurs in approximately 5% of BM, causing 30% of deaths. Lumbar puncture (but not the onset of the antibiotic treatment) should be delayed in any clinical situation suggesting the possibility of coning. The patient should be admitted to the pediatric intensive care unit for aggressive treatment of cerebral oedema with mechanical hyperventilation, sedation and mannitol infusion. Barbiturates are not recommended since they have deleterious hemodynamic effects.(ABSTRACT TRUNCATED AT 250 WORDS)
Unité de réanimation pédiatrique, hôpital Edouard-Herriot, Lyon, France.
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D002493:Central Nervous System Diseases / Q000209:etiology / Q000628:therapy*; D002648:Child; D003131:Combined Modality Therapy; D005334:Fever / Q000209:etiology; D006801:Humans; D007223:Infant; D016920:Meningitis, Bacterial / Q000150:complications / Q000628:therapy*; D012640:Seizures / Q000188:drug therapy / Q000209:etiology; D014867:Water
D014867:Water