Tefuarani N, Vince J D
Department of Child Health, Faculty of Medicine, University of Papua New Guinea.
Ann Trop Paediatr. 1992;12(4):375-83. doi: 10.1080/02724936.1992.11747602.
We report a prospective study of 108 children aged from 2 weeks to 10 years with purulent meningitis admitted to the children's wards of Port Moresby General Hospital, 105 of whom were treated with a standard management regimen using chloramphenicol (given intramuscularly initially) as the only antibiotic. The case fatality rate of 16.7% and the apparently low morbidity rate were felt to be very satisfactory in a high risk population. The medical officers' compliance with the standard antibiotic regimen was good, but was disappointing for the use of anticonvulsants. The presence of convulsions before admission or at any time in the illness, coma on admission, and a history of illness of more than 3 days duration prior to admission were strongly associated with death. We believe phenobarbitone should be given prophylactically to children less than 2 years of age who have meningitis. Further improvements in outcome are likely to be achieved not by changes in antibiotic policy but by improving early diagnosis and basic supportive care, and by preventing convulsions.
我们报告了一项对108名年龄在2周龄至10岁之间患化脓性脑膜炎儿童的前瞻性研究，这些儿童被收入莫尔斯比港总医院儿科病房，其中105名接受了以氯霉素（最初肌肉注射给药）作为唯一抗生素的标准治疗方案。在高危人群中，16.7%的病死率以及明显较低的发病率被认为非常令人满意。医务人员对标准抗生素方案的依从性良好，但在使用抗惊厥药方面却令人失望。入院前或患病期间任何时候出现惊厥、入院时昏迷以及入院前病程超过3天与死亡密切相关。我们认为，对于患有脑膜炎的2岁以下儿童应预防性给予苯巴比妥。进一步改善治疗结果可能不是通过改变抗生素政策，而是通过改善早期诊断和基本支持治疗以及预防惊厥来实现。
