[Degree of emergency for antibiotherapy in patients with presumed bacterial meningitis: experimental and clinical data].
No prospective randomized clinical studies are available to determine exactly how much time should be spent on investigation before initiating antibiotherapy in a patient with presumed bacterial meningitis. Experimental models show that antibiotics should be administered before the inflammatory response, but at this time the patient's symptoms are often unspecific. Models also demonstrate that a gain of time is beneficial at any time, in terms of inflammation, magnitude of bacteremia, or loss of hearing. Very few clinical studies address the acceptable delay between admission and administration of antibiotics and two of these show a correlation with outcome in adult meningitis. The available data supports the recommendation that hospital investigation of a patient with presumed bacterial meningitis should be conducted in such a way that efficient antimicrobial chemotherapy will be initiated within one hour after arrival.
Wolff
M
M
Service de réanimation médicale et des maladies infectieuses, hôpital Bichat - Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France. michel.wolff@bch.aphp.fr
Decazes
J-M
JM
D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy; D003937:Diagnosis, Differential; D004195:Disease Models, Animal; D004334:Drug Administration Schedule; D004630:Emergencies; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy*; D011018:Pneumonia, Pneumococcal / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000473:pathology; D011817:Rabbits; D013296:Streptococcus pneumoniae; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D000900:Anti-Bacterial Agents; D014409:Tumor Necrosis Factor-alpha