Comparative Study of Acute Bacterial Meningitis Treatment in Pediatric Patients

Abstract

Meningitis is defined as an inflammation of the membranes and cerebrospinal fluid that cover completely and bathes the brain and spinal cord. It is a serious disease and may result in permanent complications if not diagnosed and treated early. The initial treatment approach to the patient with suspected acute bacterial meningitis depends on early recognition of the meningitis syndrome, rapid diagnostic evaluation, and emergent antimicrobial and adjunctive therapy. The absence of an opsonic or bactericidal antibody is the main risk factor in most cases of meningitis caused by group B streptococcus, E coli, Hib, Streptococci (S) pneumoniae, and Neisseria (N) meningitides. Whilst meningitis cases affect all age demographics, the World Health Organization has observed the highest rates of occurrence of infection in young children. Host risk factors can be categorized into main four categories: Age and demographics, Demographic and socioeconomic factors, Immune-compromised patients, Exposure to pathogens. Common bacterial pathogens can be classified according to age, clinical setting, and risk factors. The optimal duration of antibiotic treatment in patients with bacterial meningitis is unclear, even for the most common pathogens. Traditionally, a range of 7 to 10 days is recommended for meningococcal meningitis, and longer courses (10 to 21 days) are recommended with other pathogens. In a randomized trial of therapy with ceftriaxone in children with non meningococcal meningitis (primarily Haemophillus influenzae disease), 7 days of therapy was as effective as 10 days of therapy. Clinical trials of patients with meningococcal meningitis showed that seven-day treatment regimens (including penicillin, cefotaxime, ceftriaxone, and chloramphenicol) were very effective, and the vast majority of patients were cured in four to five days Aim of this prospective study: to compare the short course antimicrobial treatment of acute bacterial meningitis versus long course; wheather the organism identified or not in Abbassia Fever Hospital. Methodology:  Phase I: Prospective study conducted in Abbassia Fever Hospital from June 2013 till December 2014.  Phase II: Meta analysis study. Results: There was statistical highly significance between the treatment plan chose and the outcomes of the patients and the p value was 0.010. R, V is the most common treatment plan used (44 cases) followed by R, V, E (17 cases) and the least common plan used was R, U, E (2 cases). The patients whom fully recovered most of them used the treatment plan R, V (38, 63.3%) followed by R, V, E (9, 15%) and to a lesser extent R, U (7, 11.7%). Organisms founded in CSF culture (e.g. enterococcus, acinobacter, N meningitis with enterococci) were the most frequent (72 cases from 84); where the mean was 8.26, SD equal ±7.01. Gram positive cocci were more common in males (7, 77.8%) as well as organisms as enterococci and acinobacter (47, 65.3%). Patients with normal CT results most of them (53, 88.3%) were fully recovered and only two of them died; these results showed high statistical significance and p value was 0.008. Patients with normal results of MRI most of them recovered completely without complications (37, 69.8%); and p value was 0.026. Most of the patients with normal MRI results are fully recovered (41, 68.3%); these was close to be statistically significant, and p value was 0.074. Patients with head trauma most of them (13, 29.5%) received the same treatment plan as those with no history of head trauma. The results close to be significant and p value was 0.081. Conclusions: The most commonly used treatment plan was ceftriaxone and vancomycin. Only 10 patients received short duration of therapy. Key words: Acute bacterial meningitis; treatment of ABM; duration of therapy; R=rocephin (ceftriaxone), V=vancomycin, E= epanutin, U= unictam.