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2011Vol. 1 No. 1:2
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THE INTERNATIONAL ARABIC JOURNALOF ANTIMICROBIAL AGENTS
alone (14, 15) . Cefotaxime and ceftriaxone also provide goodactivity against most penicillin-resistant
(16). This study has used treatment with cefotaxim and ceftriaxonefor most hospital-acquired meningitis cases, and only used forminority of the community-acquired cases (12% of
). Both vancomycin and cefotaxime should beadministered in patients with
meningitis beforeantibiotic susceptibility results are available(1, 3). The length of antimicrobial therapy courses is not xed; an analysis of ran-domized controlled trials has evaluated the ecacy and safetyof short-course antibiotic therapy for bacterial meningitis (6). This study has used long and short courses of therapy whichhas involved children (aged 3 week to 16 year) . No dierencewas demonstrated in the end of therapy in relation to clini-cal success, long-term neurological complications, long-termhearing impairment, total adverse events, and secondary nos-ocomial infections between short-course (4-7 days) and long-course (7-14 days) treatment with intravenous ceftriaxone. TheAmerican Academy of Pediatrics does not endorse a shortercourse of therapy than 5-7 days for meningococcus, 10 daysfor
and 14 days for
Although theavailable evidence is limited, some studies show no dierencebetween short-course and long-course antibiotics for bacterialmeningitis in children (7 ).According our experience we found antibiotic treatment of purulent meningitis caused by
can be safely discontinued in children who are stableby day ve. However, this approach should not be consideredthe standard of care in all meningitis cases (8).
Our guidlinesin the Fever hospital in Baghdad for treatment of community-acquired meningitis is seven days for
, ten daysfor
and no less than two weeks hospital treatment for
e. For hospital- acquired meningitis cases, the treat-ment is continued for three weeks.
We treated our patientsduring the critical time of blockade on Iraq after the dessertstorm in 1991, with great shortage in the antibiotics and othermedical supplies for Iraq and therefore the choice of the bestantimicrobial coverage was lacking.
The empirical treatment for bacterial meningitis is still the rulebefore bacterial isolation and susceptibility tests is available.Dierent antibiotics carefully chosen and given singly or incombination can oer optimum results. The length of treat-ment is still controversial, however, shorter courses can beenough for cure and being cost benet eective. Nosocomialmeningitis needs careful awareness and choice of antibioticsto cover the hospital acquired resistance pathogens for longerperiods than the community-acquired meningitis.
Types of microorganisms and anti microbial treatment in thecommunity-acquired bacterial meningitis with their CFR, (no. 170cases) Type of microorganismsNumber of cases Types of TreatmentCase FatalityRate % (CFR)
Streptococcus pneumoniae(104 cases)
40Ampicillin11.528Ampicillin +Chloremphenicol13.822Chloremphenicol 14.514Cefotaxim7.1
(44 cases)18Penicillin4.216Chloremphenicol 6.2510Chloremphenicol+ Ampicillin5.8
(22 cases)4Amicillin012Amicillin +Chloremphenicol8.336Cefotaxim0
Prompt administration of antibiotics to a patient with suspect-ed bacterial meningitis is essential for successful cure especial-ly without complication. We used ampicillin “single or in com-bination” as empirical drug for treatment of nearly 70% of thecommunity-acquired bacterial meningitis. Ampicillin providesgood coverage for gram-positive cocci, including group
B strep-tococci, enterococci, L monocytogenes
, some strains of
. Ampicillin also achieves adequate levels in cerebrospinaluid (CSF)(1, 3, 21-26). Aminoglycosides (amikacin, gentamicin,tobramycin) have good activity against most gram-negativebacilli, including
. However,aminoglycosides achieve only marginal levels in both CSF andventricular uid, even when the meninges are inamed (17, 22).Cephalosporins are empirically given for undiagnosed cases of meningitis elsewhere as recommended in many references (1-4, 18 ). We used cefotaxim singly for treatment of six cases of
meningitis and one case of Salmonella meningitis andthe CFR was higher than in its combination with ampicillin(16.7% vs. 12.5% respectively). Cephalosporin’s have no any ac-tivity against
and, therefore,should not be used as a single agent for initial treatment espe-cially among hospital-acquired cases. If the bacterial isolate issusceptible in vitro to ampicillin with a low minimum inhibitoryconcentration (MIC), then ampicillin may be continued used