Results of a multicenter survey of diagnosis and treatment for bacterial meningitis in Japan.
An evaluation committee was organized to evaluate 464 cases of bacterial meningitis treated at 108 nationwide medical facilities participating in this survey between April 2004 and January 2007. There were 413 evaluable cases of bacterial meningitis, including 342 children (82.8%) and 71 adults (17.2%). Haemophilus influenzae (217 cases, 63.5%) and Streptococcus pneumoniae (35 cases, 49.3%) were the most frequent pathogens for meningitis in children and adults, respectively. The most used initial therapy for children was carbapenem + cephalosporin therapy (212 cases, 61.9%). Of the 333 children included in efficacy evaluation, 320 (96.1%) were rated as remission, 10 (3.0%) as partial remission, and three (0.9%) as poor response. The combination therapy with two drugs was also most often used in adults (41 cases, 57.7%). In efficacy analysis in 60 adults, remission was observed in 50 (83.3%), partial remission in five (8.3%) and poor response in five (8.3%). In prognosis analysis, 273 (80.3%) among 340 children were alive at the end of treatment without sequelae, but one (0.3%) died by the end of treatment, and 64 (18.8%) had sequelae. Of all adults, six (8.5%) died of bacterial meningitis and 23 (32.4%) had sequelae at the end of treatment. Among the patients followed up for 1 year, 26 (12.3%) of 211 children and three (7.7%) of 39 adults had sequelae. The selection of drugs and its dose level of many cases were appropriate, but the dose level of several cases was inappropriate. It is necessary to spread the method of proper antibiotic therapy.
Department of Pediatrics, Asahikawa Kosei Hospital, 1-24 Asahikawa, Hokkaido 078-8211, Japan. sakhiro@mac.com
Hiroshi
H
Sakata
Yoshitake
Y
Sato
Masato
M
Nonoyama
Tsunekazu
T
Haruta
Kazunobu
K
Ouchi
Satoru
S
Yamaguchi
Keisuke
K
Sunakawa
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015780:Carbapenems / Q000008:administration & dosage / Q000627:therapeutic use*; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006193:Haemophilus influenzae / Q000187:drug effects; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007564:Japan / Q000453:epidemiology; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D008583:Meningitis, Haemophilus / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D008586:Meningitis, Pneumococcal / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D008875:Middle Aged; D011379:Prognosis; D013296:Streptococcus pneumoniae / Q000187:drug effects; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002511:Cephalosporins