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KMID : 0381219750070090608
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Journal of RIMSK
1975 Volume.7 No. 9 p.608 ~ p.611
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Some Problems on the Treatment of Bacterial Meningitis in Infants and Children
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Abstract
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Purulent meningitis in infants and children remains, despite potent specific antibiotics, a serious threat to life and neurologic competence.
The highest mortality rate (30^´50%) occurs in neonates and young infants with meningitis due to gram-negative organisms and Staphylococcus Aureus and in those already in coma or near coma at diagnosis. The symptoms vary greatly with age. Nuchal rigidity, especially in the younger age group, may not be present and the diagnosis must be considered if the neonate or younger age group reveals poor general conditions including poor sucking, irritability, lethargy, nausea or vomitings.
The cnly method to increase survival rate and minimize sequalle from the disease is early detection and proper treatment of the disease. The choice of antibiotics should be individualized and considered by age, causative agent and time of diagnosis. There is high incidence of convulsions in infants up to about 18 months of age in this disease. The prophylactic use of anticonvulsant, especially phenobarbital, 3^´5 mg/kg/day, is strongly advocated during the acute phase.
Cerebral edema may cause inappropriate ADH secretion and hyponatremia is a frequent complication of this disease, it is best avoided by judicious fluid administration and treated by hypertonic saline or diuretics. The incidence of subdural effusion in young infants with meningitis approaches 50% and less common after 18 months
Symptoms including prolongation or recurrence of fever. irritability and convulsion should be suspected the appearance of this complication and managed as early as possible.
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