Pathogen spectrum in bacterial meningitis in childhood and subsequent therapeutic strategy

: In a total of 223 children over one month old suffering from purulent meningitis, there was a predominance (n = 96) of meningococci over hemophilus influenzae (n = 68) and pneumococci (n = 59). Crucial to therapeutic strategy for purulent meningitis is early diagnosis, in our laboratory covering both liquor and blood cultures. Initial therapy has to take account of these three chief causal agents. We have not as yet observed any resistance to penicillin from meningococci or pneumococci, and none of the liquor-cultivated hemophilus influenzae stock has been resistant to ampicillin. In the first two years of life, initial therapy for bacterial meningitis should include ampicillin, a liberal (300-400 mg/kg KM/d) dosage continuing to be important after the onset of improvement. In view of the lack of resistance of the causal agents cultivated, we had hitherto no cell to deploy modern cephalosporins in cases of bacterial meningitis in children.