Bacterial meningitis in children

Critical review of current concepts

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Acute bacterial meningitis is still an important cause of morbidity and mortality in children worldwide. Recently, Haemophilus influenzae type b (Hib), once a common cause of meningitis, has virtually disappeared in developed nations, reflecting the overwhelming success of Hib vaccination. Unfortunately, Hib remains a significant pathogen in resource-poor countries. The introduction of the conjugated pneumococcal vaccine in 2000 may lead to similar future trends as witnessed with Hib. As the resistance of Streptococcus pneumoniae to penicillin and cephalosporins continues to evolve, vancomycin has become an important antibacterial in the treatment of bacterial meningitis. The unreliable penetration of this agent into cerebrospinal fluid is of concern, which is compounded by the controversial use of corticosteroids in paediatric meningitis. Some data suggest that in certain situations the addition of rifampicin (rifampin) to ceftriaxone may be a better choice. While dexamethasone is now considered the standard adjunctive therapy in the treatment of pneumococcal meningitis in adult patients, the benefit in children is not so clear and remains controversial; thus, there is no definitive paediatric recommendation. Several anti-inflammatory agents currently under investigation may be used in the future as adjunctive therapy for bacterial meningitis. It is clear that the current concepts in the treatment of childhood bacterial meningitis are evolving, and other antibacterial options and possible alternatives such as carbapenems and fluoroquinolones should be considered. Fluid restriction because of the Syndrome of Inappropriate Antidiuretic Hormone Secretion is widely advocated and used. Yet, this practice was recently challenged. It seems that most patients with meningitis do not need fluid restriction. The overwhelming success of the conjugated Hib vaccine and the encouraging results of the new conjugated pneumococcal and meningococcal vaccines suggest that the ideal management of bacterial meningitis is prevention and vaccines development against the most common bacterial agents are the best solution.

Original languageEnglish (US)
Pages (from-to)1097-1112
Number of pages16
JournalDrugs
Volume65
Issue number8
DOIs
StatePublished - 2005
Externally publishedYes

Fingerprint

Haemophilus influenzae type b
Pneumococcal Vaccines
Pediatrics
Bacterial Meningitides
Vaccines
Meningococcal Vaccines
Cerebrospinal fluid
Carbapenems
Fluids
Meningitis
Ceftriaxone
Fluoroquinolones
Pathogens
Cephalosporins
Vancomycin
Rifampin
Vasopressins
Penicillins
Dexamethasone
Adrenal Cortex Hormones

ASJC Scopus subject areas

  • Toxicology
  • Health, Toxicology and Mutagenesis

Cite this

Bacterial meningitis in children : Critical review of current concepts. / Yogev, Ram; Guzman-Cottrill, Judith.

In: Drugs, Vol. 65, No. 8, 2005, p. 1097-1112.

Research output: Contribution to journalArticle

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