Abstract
Nine hundred seventy cases of childhood bacterial meningitis treated at 107 institutions in Japan from 1979 through 1984 were studied using questionnaire.
The number of cases that underwent antimicrobial monotherapy remained nearly constant during the study period, but cases of therapies with B-lactam combined with aminoglycosides (AGs) decreased in number and a gradual increase in the use of B-lactam combined with non-AGs antibiotics including β-lactam (Non AGs) was observed.
A trend showing decrease in case fatality rate (CFR) was observed except that CFR for Gram-positive bacterial infections treated with B-lactam+AGs remained at a same level.
Cases treated with antibiotics were classified into 3 groups according to major etiological pathogens.
Cases with Staphylococcus aureus gave a poor prognosis, among 27 total cases, CFR was 28.6% (2/7) with monotherapy, 50. OM (6/12) with, 9-lactam+ AGs and 37.5% (3/8) with B-lactam+NonAGs (P <0.1).
Among 100 cases of group B Streptococcus (GBS), CFR was 20. OM as a whole, 17.3% (9/52) for monotherapy and 34.5% (10/29) for B-lactam+ AGs (P < 0.1).
Among 198 cases of Streptococcus pneumoniae, CFR was 12.1% as a whole, and was 12.3% (18/146) with monotherapy. CFR for the cases treated with β-lactam+ AGs was 20.8% (5/24) and with j3-lactam+Non AGs was 3.6% (1/28)(P<0. 1).
CFR for 292 cases of Haemophilus influenzae meningitis was fairly low, and was 6.1% (9/148) with monotherapy, 7.4% (5/68) with β-lactam+ AGs and 3.9% (3/76) with B-lactam+Non AGs, thus very slight differences were observed among the 3 groups of treatment.
Among 111 cases of Escherichia coli, monotherapy and B-lactam+Non AGs gave 6.5% (2β1) CFR, and 5.6% (1/18) CFR, respectively, whereas 13-lactam+ AGs showed CFR of 19.4% (12/62), demonstrating a significant difference tendency (P <0.1). Similar tendencies were observed in the cases of Listeria monocytogenes, Proteus mirabilis, Pseudomonas aeruginosa and Enterococcus faecalis. Contrary to the high CFR observed with the β-lactam+AGs treatment, significantly low CFR was frequently obtained in cases treated with a combination of penicillins with cephalosporins including latamoxef or B-lactam with chloramphenicol.
Infections with GBS, E. coli, and P. mirabilis occurred largely in the age between 0 to 6 months and CFR was especially high in the very young. CFR for cases treated with B-lactam+AGs was higher than CFR for cases with monotherapy. This was particularly true for GBS (P<0.05). These facts point out that ampicillin+AGs treatment may have a problem in the treatment of neonates.
