The treatment and outcome of intracranial infections of otogenic origin.

Of 1321 patients with intracranial (IC) infection studied, the infection occurred as a direct result of middle ear disease in 36 (3%). The presenting clinical symptoms were those of diffuse meningeal irritation in 23 and of localized infection in the remaining 13. In the 23 patients with diffuse meningitis, the IC infection followed Acute Suppurative Otitis Media (ASOM) in only four and followed Chronic Suppurative Otitis Media (CSOM) in the remaining 19. Five of these 23 patients died soon after admission as their general condition was very severe. The final diagnosis in the 13 patients with localized meningeal inflammation was, brain abscess in seven, extradural abscess in four, lateral sinus thrombosis in two. All these patients underwent surgery, and except for one patient who died 3 days post-operative all recovered without sequelae.

Intramuscular ceftriaxone versus ampicillin-chloramphenicol in childhood bacterial meningitis.

70 children aged 4 months-12 years, with bacteriologically proven bacterial meningitis were treated with either intramuscular (IM) ceftriaxone (CFT) 100 mg/kg given once daily, or with combined IM ampicillin 160 mg/kg/day and IM chloramphenicol 100 mg/kg/day (AMC) given every 6 h. There were 35 children in each of the treatment groups. The children in both groups were comparable with regard to age, sex, duration of illness, and state of consciousness. 29 children in the CFT group and 26 in the AMC group recovered without any permanent complications or sequelae. Of the 15 children who died 10 (3 in the CFT and 7 in the AMC group) were in deep coma when treatment was started. Intramuscular CFT given once daily proved effective and much easier to administer than our standard hospital therapy with combined AMC given every 6 h IM.

Parenteral aztreonam in the treatment of Haemophilus influenzae type b meningitis in Egyptian children.

13 children, 8 girls and 5 boys, aged 2-15 months (mean 8.5 months), with Haemophilus influenzae meningitis were treated with aztreonam. Aztreonam was administered intramuscularly in a dose of 50 mg/kg every 8 h. 10 of the infants were in coma and 3 were drowsy when first examined in hospital. All except 2 infants, who were in coma and who died within 24 h of starting therapy, recovered quickly. All patients became fully alert within 4-5 days and afebrile within 5 to 6 days.

Ocular complications in meningitis: "fifteen years study".

The incidence of ocular complications in 4102 patients with meningitis was studied during a 15 year period. Cranial nerve involvement was detected in 23% of patients (sixth cranial nerve in 16.5%; third and seventh nerve in 3.0% each; and fourth and fifth nerve in 0.1% each). Pupillary changes were detected in 82% and fundus changes in 5.2% of patients.

Ceftriaxone alone compared to ampicillin and chloramphenicol in the treatment of bacterial meningitis.

One hundred patients (71 males and 29 females) with bacterial meningitis were randomly assigned into two therapeutic regimens. Patients in group I were intravenously given ceftriaxone (CRO: Rocephin) to adults and intramuscularly to children once daily in a dose of 100 mg/kg/day. Patients in group II received ampicillin 160 mg/kg/day and chloramphenicol (AMCL) 100 mg/kg/day (i.v. to adults and i.m. to children) every 6 h. No significant difference was observed between the two therapeutic regimens with regard to mortality, time taken to become afebrile, fully alert and sequelae. Seven patients in the CRO group died compared to 10 in the AMCL group. The mean number of days taken to become afebrile were 3.4 and 3.5, and to become fully alert 3.9 and 3.5 for groups I and II, respectively. CRO administered in a single daily dose appears to be as effective as a combination of ampicillin and chloramphenicol given every 6 h in the treatment of acute bacterial meningitis. However, the once daily dose is more appropriate for use especially in areas where nursing care is limited.

Successful treatment of typhoid fever in children with parenteral ceftriaxone.

Eight children, seriously ill with bacteriologically proven Salmonella typhi septicemia, were successfully treated with a single daily intramuscular injection of 2 g ceftriaxone given for 5-7 days. All children improved clinically within 48 h of starting therapy and all except 1 became afebrile within 5 days. None relapsed during the 4-week follow-up study.

Ceftriaxone compared with a combination of ampicillin and chloramphenicol in the treatment of bacterial meningitis in adults.

Thirty patients, 25 males and 5 females, aged 16-30 years (mean 21.8 years) with bacterial meningitis were assigned randomly into one of two therapeutic regimens. Patients in Group I received ceftriaxone 100 mg/kg (max 4 g) intravenously (i.v.) once daily. Those in Group II received ampicillin i.v. 160 mg/kg/day plus chloramphenicol i.v. 100 mg/kg/day every 6 h. Of the 15 patients in Group I, N. meningitidis was isolated from 11 patients and S. pneumoniae from 4; and of the 15 patients in Group II, N. meningitidis was isolated from 10 patients and S. pneumoniae from 5. Response to therapy as measured by mortality, time taken for defervescence and for patients to regain full consciousness were comparable in the two groups. One patient in each group died; both died within 24 h of initiation of therapy. The mean no. of days taken to become afebrile were 3.4 and 3.5 and to regain full consciousness were 3.9 and 3.5 for Groups I and II respectively. Ceftriaxone given i.v. appears to be as effective as a combination of ampicillin and chloramphenicol in the treatment of adult patients with meningitis due to N. meningitidis and S. pneumoniae. However, the once-daily schedule of ceftriaxone is more convenient, saving nursing time and expense.

Tuberculous meningitis--clinical and laboratory review of 100 patients.

In developing countries tuberculous meningitis is a difficult infection to differentiate from other central nervous system (CNS) infections. This paper presents the history, physical findings, laboratory data, and clinical course of 100 patients who were admitted to a special ward and had CSF cultures positive for Mycobacterium tuberculosis. Fifty-four patients were comatose when admitted and 76 had meningeal signs. Mean admission CSF values were WBC 531, glucose 23 mg/dl, and protein 166 mg/dl. Only two CSF AFB smears were positive. Sixty-one percent of the chest X-rays taken were consistent with pulmonary tuberculous and 39% were normal. Twenty-four patients died within the first week after admission, before the clinical diagnosis was made and anti-tuberculous therapy could be started. Fifty-three of 76 patients given antituberculous therapy died. Neurologic sequelae developed in 48% of the survivors. The high mortality and morbidity rates in this patient-group were due to the severity of illness on admission and the predominance of children (54%).

The value of ethambutol in the treatment of tuberculous meningitis.

This is a prospective treatment study of 86 patients with tuberculous meningitis admitted to the Abbassia Fever Hospital Cairo, Egypt. The causative organism was cultured from the cerebro spinal fluidin 47 patients, was identified by Zeihl Nelson stain in five and in the remaining 34 patients the diagnosis was based on the clinical course and changes in the CSF chemistry and cell count. The data indicate that ethambutol can be used as a companion drug to INH and streptomycin in the treatment of the disease and that the mortality is directly dependent on the state of consciousness upon initiation of therapy.

The value of epicillin and ampicillin in the treatment of meningococcal and pneumococcal meningitis.

96 patients with meningitis due to Neisseria meningitidis and Diplococcus pneumoniae were treated with epicillin or ampicillin according to a predesigned randomization chart. Results indicate that epicillin and ampicillin are effective single drugs in the treatment of meningococcal and pneumococcal meningitis. No adverse reactions were noted with either drug and they were comparable in their efficacy.