Vol.59 No.2 March 2011
Prognosis and antibiotic treatment of bacterial meningitis in adults
1)Department of Pediatrics, Asahikawa Kosei Hospital, 1-24, Asahikawa, Hokkaido, Japan
2)Laboratory of Infectious Diseases Science, Graduate School of Infection Control Science, Kitasato University
3)Department of Pediatrics, Japan Medical Alliance, Ebina General Hospital
4)Department of Pediatrics, Fuji Heavy Industries Ltd, Health Insurance Society Ota General Hospital
5)Department of Pediatrics, Kobe City Medical Center General Hospital
6)Department of Pediatrics, Kawasaki Medical School
7)Ito Child Clinic
Abstract
Of 466 subjects with bacterial meningitis treated at 108 institutions between April 2004 and January 2007, the Assessment Committee studied the relationship between the initial treatment drug and prognosis in 66 adults, after excluding those with an uncertain diagnosis or nonassessable records. Prognosis was considered unfavorable if meningitis sequelae, such as quadriplegia, deafness, or epilepsy were present at 3-month follow-up or if meningitis directly caused death. Based on this definition, 23 adults (34.8%) had a poor prognosis. No difference was seen in prognosis related to the causative pathogen or initial symptoms. The mean age of those with an unfavorable prognosis was 65.9±10.1 years, and that of those with a favorable prognosis was 55.7±16.7 years a significant difference between groups (p<0.01). Unfavorable prognosis was significantly higher in those whose treatment was initiated at 3 days or later after disease onset than in those whose treatment was initiated earlier stage (p<0.05). Although no significant differences in clinical symptoms were seen between favorable and unfavorable prognosis, laboratory findings showed significantly higher serum CRP (p<0.05), lower cerebrospinal fluid cell count (p<0.01), lower cerebrospinal glucose (p<0.05), and higher cerebrospinal fluid protein in those with an unfavorable prognosis group. As to the effect of the initial treatment drug, an unfavorable prognosis was noted in 3/16 subjects (18.8%) treated with meropenem and 4/11 (36.4%) treated with cefotaxime plus ampicillin. In many subjects, drugs were used at doses not sufficient to bacterial meningitis. Among those with meningitis due to Streptococcus pneumoniae, prognosis was unfavorable in 5/14 subjects (35.7%) given sufficient antibiotics and in 3/4 (75.0%) whose doses were insufficient.
Key word
bacterial meningitis, Streptococcus pneumoniae, antimicrobial chemotherapy
Received
October 26, 2010
Accepted
November 15, 2010
Jpn. J. Chemother. 59 (2): 158-162, 2011
