Bacterial meningitis in 366 children in the Netherlands, 1982-1983. Epidemiology and antibiotic therapy.

Records of 366 children 0-15 years with bacterial meningitis (April 1982-March 1983) were reviewed in the framework of a medical audit. The general epidemiological pattern and the antibiotics administered are described and the patients in general hospitals are compared with those in academic hospitals. H. influenzae has been isolated from 31% of patients, N. meningitidis from 23% and S. pneumoniae from 10%. Case-fatality ratio was 6.6% overall, but it was higher in disease due to rare pathogens like E. coli and group B-Streptococcus (up to 25%). These rare pathogens were more common among patients in academic than in general hospitals. However, this difference was not significant, nor were differences in age distribution or case-fatality ratio between the two hospital categories. As initial therapy chloramphenicol plus a penicillin were administered to 30% of patients. On the fifth day of treatment ampicillin was the most frequently used antibiotic in general hospitals (31%), but in academic centres the above-mentioned combination (27%) and penicillin alone (24%) were most popular. It is argued that new antibiotics need to be evaluated carefully. Because this necessitates several hundreds of patients, multi-centered randomised trials should be carried out.