title: Trends in empirical chemotherapy of bacterial meningitis in children aged more than 4 months in Japan: a survey from 1997 through 2008.
abstract: Bacterial meningitis is a serious problem in pediatric clinics and, therefore, needs urgent and empirical chemotherapy. We investigated 1,116 cases of empirical chemotherapy of patients aged older than 4 months from 1997 through 2008 by sending questionnaires. A single antibiotic treatment was carried out in less than 30% of the cases throughout the years, whereas the combination of two antibiotics had been practiced in more than 70% of the cases. The main antibiotics used were cephalosporins, carbapenems, and ampicillin. Combinatory use of ampicillin and cephalosporin was carried out in 74.7-82.7% of cases in 1997-2000, but sharply declined thereafter to 0-13.8% in 2004-2008. However, the combination of carbapenem and cephalosporin compensated for the decline, increasing from 3.8-6.6% in 1998-1999 to 79.5-89.9% in 2005-2008. The breakdown in the use of cephalosporins, carbapenems, and ampicillin in two-drug combinatory therapy was as follows. (i) Use of cefotaxime was 61.8-75.3% in 1997-2001, but decreased to nearly 50%, equivalent to the level of ceftriaxone use in 2003-2008. (ii) Use of ampicillin dropped from 74.7-92.3% in 1997-2000 to 4.6% in 2008, and this decreased level was compensated for by the use of carbapenems. Overall, combinatory chemotherapy of the third-generation cephalosporins and carbapenems seems to be practical. The discussion in this report includes the difference between Japan and the United States in the prevalence of the causative agents and the use of antibiotics. These studies provide information on trends in the treatment of children's meningitis in Japan and will be useful for the design of future empirical chemotherapy.
authors.affiliation: Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan.
authors.forename: Fuminori
authors.initials: F
authors.lastname: Sakai
authors.forename: Hideaki
authors.initials: H
authors.lastname: Hanaki
authors.forename: Yurika
authors.initials: Y
authors.lastname: Ikeda-Dantsuji
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Hirao
authors.forename: Masato
authors.initials: M
authors.lastname: Nonoyama
authors.forename: Satoshi
authors.initials: S
authors.lastname: Iwata
authors.forename: Yoshitake
authors.initials: Y
authors.lastname: Sato
authors.forename: Hironobu
authors.initials: H
authors.lastname: Akita
authors.forename: Taiji
authors.initials: T
authors.lastname: Nakae
authors.forename: Keisuke
authors.initials: K
authors.lastname: Sunakawa
mesh_terms: D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004358:Drug Therapy / Q000639:trends; D005260:Female; D006801:Humans; D007223:Infant; D007564:Japan; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents