[Studies of treatment for Haemophilus influenzae type b meningitis in children].

We summarize 41 cases of bacterial meningitis in the last 11 years caused by Haemophilus influenzae. All isolates were serotype b strain (Hib). Initial chemotherapy was started with ceftriaxone (CTRX) in 22 cases, ampicillin plus cefotaxime (CTX) in 9, CTRX plus panipenem/betamipron in 5, and CTX in 2. Some 31 cases were treated mainly with CTRX. Although therapeutic antibiotics showed good susceptibility for isolates, 8 complicated cases (19.5%) occurred. Sequalae were observed in 7 (17.1%) but none were fatal. Five strains with elevated MIC of CTX (0.12 to 1 microg/mL) recovered after 2001, and 3 of 5 strains also showed elevated MIC of CTRX (0.12 to 0.5 microg/mL), but all were cured completely with CTRX. At present, no treatment failures due to antibiotic resistance have been observed, and CTRX remains suitable as initial therapy for Hib meningitis. A decline in susceptibility for third-generation cephalosporin against beta-lactamase-nonproducing ampicillin-resistant H. influenzae is emerging, however, so it will be necessary to consider combination therapy with CTRX given the foreseeable trend in MICs.

[Two cases of meningitis caused by the same Haemophilus influenzae type B strain in a nursery at a 3-month interval].

We present 2 cases of meningitis caused by the same Haemophilus influenzae type b (Hib) strain in a nursery at a 3-month interval. Causative agents isolated showed good susceptibility to beta-lactams and both patients recovered without any sequelae. Survey culture at each occurrence of meningitis showed 10 asymptomatic nasopharyngeal carriers. Oral rifampin was administrated to all staff and infants, but 2 carriers were found a month later from chemoprophylaxis. Pulsed-field gel electrophoresis analysis showed that the two strains isolated from meningitis patients and 12 from asymptomatic carriers were apparently identical. When systemic Hib infection occurs in a nursery, other infants may be at high risk for secondary disease. It is difficult, however, to eliminate Hib carriage by chemoprophylaxis, indicating that Hib vaccination to prevent systemic Hib infection is necessary in Japan.