Shorter versus longer duration of antibiotic treatment in children with bacterial meningitis: a systematic review and meta-analysis.

The optimal duration of antibiotic treatment for the most common bacterial meningitis etiologies in the pediatric population, namely Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, is not well-established in the literature. Therefore, we aimed to perform an updated meta-analysis comparing shorter versus longer antibiotic treatment in children with meningitis. PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials (RCTs) that compared shorter (up to 7 days) versus longer (10 days or double the days of the equivalent short course) duration of antibiotic treatment in children with meningitis and reported the outcomes of treatment failure, death, neurologic sequelae, non-neurologic complications, hearing impairment, nosocomial infection, and relapse. Heterogeneity was examined with I2 statistics. RevMan 5.4.1 was used for statistical analysis and RoB-2 (Cochrane) for risk of bias assessment. Of 684 search results, 6 RCTs were included, with a cohort of 1333 children ages 3 weeks to 15.5 years, of whom 49.51% underwent a short antibiotic course. All RCTs included monotherapy with ceftriaxone, except one, which added vancomycin as well. No differences were found comparing the short and long duration of therapy concerning treatment failure, relapse, mortality, and neurologic complications at discharge and at follow-up.  Conclusion: Because no statistically significant differences were found between groups for the analyzed outcomes, the results of this meta-analysis support shorter therapy. However, generalizing these results to complicated meningitis and infections caused by other pathogens should be made with caution. (PROSPERO identifier: CRD42022369843). What is Known: • Current recommendations on the duration of antibiotic therapy for bacterial meningitis are mostly based on clinical practice. • Defining an optimal duration of antibiotic therapy is essential for antimicrobial stewardship achievement, improving patient outcomes, and minimizing adverse effects. What is New: • There are no differences between shorter versus longer antibiotic treatment duration in regard to treatment failure, relapse, mortality, neurologic complications, and hearing impairment at discharge and at follow-up.

Honey and Its Antimicrobial Properties: A Function of a Single Component, or the Sum of Its Parts?

INTRODUCTION: Honey is known for exhibiting antibacterial properties, indicating its use as part of traditional medicine since the early ages. With the advent of antibiotic-resistant bacteria, the need for alternative antimicrobials has outpaced the actual development of novel, broad-spectrum antibiotics. Previous research has revolved around the sugar content of honey because its sweetness makes it an attractive food source. However, research assessing the protein and lipid components of honey is lagging behind that of its sugar counterpart. The goal of this investigation was to examine the antimicrobial properties of honey and to identify any distinct proteins or lipids. METHODS: In order to isolate individual peptides and lipids, the different samples of local and foreign-sourced honeys were dialyzed, and the resulting dialysate proteins were screened via gel electrophoresis (sodium dodecyl-sulfate polyacrylamide gel electrophoresis [SDS-PAGE]) with Coomassie blue and silver stain, while lipids were examined using thin layer chromatography (TLC). To assess antimicrobial potency, a series of Kirby-Bauer disc diffusion assays was performed on Mueller-Hinton agar using different types of raw honey with Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Escherichia coli, and Bacillus subtilis. The process was then repeated using the peptide extracts from the dialyzed fractions of the honeys. RESULTS: The SDS-PAGE trials revealed repetitive promising protein bands across several gels below 75kDa with both Coomassie blue and silver staining. The TLC analysis of varying raw honey samples consistently demonstrated the presence of medium and long-chain fatty acids, likely in the range of C12-C14. In the disc diffusion assays, the greatest amount of inhibition was seen when the honeys were tested as a whole instead of its constituent parts. CONCLUSION: Instead of an individual component acting as the key to honey's action against bacteria, it appears there is a synergistic relationship amongst the sugars, proteins, and lipids that make each honey unique.