In vitro antibiotic sensitivity pattern of common bacterial isolates from cases of acute bacterial meningitis with special reference to ceftriaxone.

Ceftriaxone (RO 13-9904) has only recently been introduced in Benghazi and many parts of the word. We determined its in-vitro antibacterial activity against the primary aetiological agents of childhood meningitis in Benghazi, that included eighteen (23.3%) strains of H. influenzae, 17 (22.1%) of Str. pneumoniae and 1 (1.3%) of N. meningitidis isolated from 77 cases of acute purulent meningitis above the age of neonatal period. All strains of H. influenzae. Str. pneumoniae and N. meningitidis were sensitive to ceftriaxone and showed wide zones of inhibition by the disc diffusion technique of Kirby-Bauer. Ampicillin and chloramphenicol resistance was observed for H. influenzae (23% and 11% respectively), and Str. pneumoniae (12% and 0% respectively), in addition, 18% of strains of Str. pneumoniae showed resistance to penicillin. The broad spectrum activity of ceftriaxone has been confirmed for our locality and this finding, together with its exceptionally long half-life, excellent penetration into the C.S.F. and ease of administration (single daily dose) warrants it as the drug of choice in empherical treatment of cases of acute bacterial meningitis in children in Benghazi and in cases where resistance to ampicillin and chloramphenicol are found on subsequent testing.

Dexamethasone as an adjunctive treatment of bacterial meningitis.

This study was conducted on 77 Libyan infants and children aged month to 10 years with acute bacterial meningitis. Upon admission, the patients were divided randomly in two groups. Group I (38 patients) received ceftriaxone plus dexamethasone i.v. Group II (39 patients) received ceftriaxone alone. Both groups were compared for mean changes in CSF sugar, CSF protein and CSF polymorph count at 4th day of treatment. There was a significant difference between the two groups in CSF sugar and protein changes (P < 0.05) but not in CSF polymorph (P > 0.05). Both groups showed prompt clinical response and similar occurrence of acute complications, fatality rate and permanent neurological sequelae. However, group I manifested shorter duration of fever (P < 0.05). Dexamethasone improved the inflammatory reaction in acute bacterial meningitis and shortened the duration of fever but it did not have any significant effect on the fatality and the occurrence of neurological sequelae of this disease.