title: Treatment of Salmonella meningitis: two case reports and a review of the literature.
abstract: BACKGROUND
  Salmonella species now represent a leading cause of Gram-negative bacterial meningitis in the developing world. Various drugs have been used for the treatment of Salmonella meningitis over the past decades, but mortality, neurologic sequelae and relapse rates remain high. In this report we describe two children aged 8 and 9 months who presented within a week to our hospital with Salmonella meningitis. They were treated with penicillin and chloramphenicol but progressed rapidly to death within 48 h.
  
  
  OBJECTIVE
  The aim of this article is to review all published English literature on the treatment of Salmonella meningitis and identify the best drug option for its treatment. This was done by comparing the outcomes such as cure, failure, relapse, and death rates.
  
  
  METHODS
  A Medline electronic search was carried out to find and retrieve articles that have been published since 1987, when the last review of Salmonella meningitis was done.
  
  
  RESULTS
  Salmonella typhimurium was the commonest organism reported, and 89.7% of infections occurred in children less than 1 year old. Fluoroquinolones had a cure rate of 88.9%, while the third-generation cephalosporins had a cure rate of 84.6%. Conventional antibiotics (chloramphenicol, ampicillin, and cotrimoxazole) had a cure rate of 41.2%, a relapse rate of 11.8%, and an associated mortality of 44.7%. Treatment with fluoroquinolone and imipenem resulted in no deaths. There were, however, only two cases that were treated with imipenem.
  
  
  CONCLUSIONS
  When Salmonella meningitis is suspected, third-generation cephalosporins, with or without a fluoroquinolone, may be the best option for treatment.
authors.affiliation: Department of Child Health, Komfo Anokye Teaching Hospital, PO Box 1934, Kumasi, Ghana. malab@ghana.com
authors.forename: Alex
authors.initials: A
authors.lastname: Owusu-Ofori
authors.forename: W Michael
authors.initials: WM
authors.lastname: Scheld
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D012480:Salmonella Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality
chemical_list: D000890:Anti-Infective Agents