Çocuk Sağlığı ve Hastalıkları Dergisi 2003 , Vol 46 , Num 3
Meningitis III: Treatment
Güler Kanra1, Mehmet Ceyhan1, Ateş Kara2
Hacettepe Üniversitesi Tıp Fakültesi 1Pediatri Profesörü, 2Pediatri Uzmanı After the introduction of antibiotics for bacterial meningitis treatment in the 1930s and 40s, complication rates significantly reduced, whereas once it absolutely resulted in mortality. Since the emergence of new resistance patterns in the responsible microorganisms is a serious problem, the importance of treatment choice, which is usually started empirically, can be easily recognized. Both morbidity and mortality are directly related to the timing of urgently started antibiotherapy, which is usually empiric as the causative agent is still unknown. Today, all the antibiotherapy must be parenteral and completed during the hospital stay. Some special features should be considered for antibiotic choice. First, they must pass the blood-brain barrier effectively and sustain sufficient levels in the cerebrospinal fluid (CSF) where the infection is. Second, the antibiotic must have bactericidal activity in order to achieve rapid eradication of the microorganism. In consideration of the above - mentioned factors, the recommended meningitis antibiotherapy according to age groups is as follows: combination of ampicillin and third-generation cephalosporins (cefotaxime, ceftriaxone) for neonates, combination of ampicillin and third-generation cephalosporins for infants between 1-3 months, third-generation cephalosporins for children up to five years, third-generation cephalosporins for cases over five years, and a combination of ampicillin and third generation cephalosporins for the geriatric population. Glycopeptides might be added to the therapy regimen according to the resistance pattern in the relevant regimen for the most common etiologic agent after five years of age, S. pneumonia. Therapy should be directed if any organism is isolated. Since many of the complications are related with inflammation, the combination of antimicrobial and anti-inflammatory therapy is widely accepted. Anahtar Kelimeler : menenjit, çocuk, invazif enfeksiyonlar, tedavi, meningitis, childhood, invasive infections, treatment
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