[Clinical features and evaluation of initial antibiotic treatment in 125 cases with purulent meningitis in infancy and childhood].

A survey of purulent meningitis in infancy and childhood from 1980 through 1986 was made by sending questionnaires to 32 pediatric institutions in Aichi, Gifu and Shizuoka prefectures. Case cards of 125 patients were collected and analyzed. The results are summarized as follows: 1. The sex ratio (male/female) was 1.78. The age distribution for all patients was as follows: younger than 1 month, 24.8%; 1-12 months, 32.8%; 1 year, 19.2%; 2-5 years, 16.0%; older than 6 years, 7.2%. Nearly 3/4 of all purulent meningitis cases occurred in infancy. 2. The isolation rate of causative organisms was 71.2%. The 4 major causative organisms were Haemophilus sp. (28 cases), Streptococcus pneumoniae (14 cases), Streptococcus agalactiae (13 cases), and Escherichia coli (12 cases). Haemophilus sp. was dominant in patients over 3 months of age, and S. pneumoniae was noted in all age groups. The latter 2 were dominant under 3 months of age. 3. The outcome of 125 cases was as follows: cured, 73 cases (58.4%); improved, 26 cases (20.8%); dead, 15 cases (12.0%); unknown, 11 cases (8.8%). As to the outcome by age, the mortality of infants within 1 month old was the highest, 29.0%, and then decreased with increasing age. As to the outcome by causative organisms, Haemophilus sp. and E. coli were associated with good outcome, whereas S. pneumoniae and S. agalactiae with poor outcome. 4. Among several antibiotics, ampicillin was the most frequently used in 94 cases, followed by cefotaxime in 50 cases. 5. As to the initial antibiotic treatment, 51 cases were treated with penicillins (PCs) (including PCs + aminoglycosides (AGs], 9 cases with cephalosporins group I, II, IV, (CEPs I, II, IV) (including CEPs I, II, IV + AGs), 25 cases with CEPs V (including CEPs V + AGs) and 31 cases with CEPs V + PCs (including CEPs V + PCs + AGs). No significant differences were observed in the outcome among these initial treatment group. 6. Compared with the initial treatments of CEPs V or CEPs V + PCs groups, other antibiotics were used more frequently in those of PCs + AGs and CEPs I, II, IV groups. In the light of this analysis, the initial treatments of purulent meningitis with PCs + AGs or CEPs I, II, IV were not so effective as those with CEPs V or CEPs V + PCs.