THE TREND OF CHILDHOOD BACTERIAL MENINGITIS IN JAPAN (1979-1984):PART 3. ON THE ANTIBIOTIC THERAPY AND PROGNOSIS

: We studied 973 cases of childhood bacterial meningitis from 1979 through 1984 by means of questionnaire. Monotherapy was carried out in 47.9% of patients with case mortality of 10.3%, whereas those treated with 2 and 3 antibiotics revealed higher rates of 15.8% and 13.5%, respectively. Penicillins (PCs) were the most frequently used for monotherapy, and ampicillin (ABPC) accounted for 48.7%, then followed by cephalosporins (CEPs) group V including latamoxef (LMOX) for 26.8%, with fatality rates of 11.0% for the former and 9.6% for the latter. Chloramphenicol (CP) was used in 19 cases, 4 cases were treated with antibiotics other than PCs, CEPs, CP and aminoglycosides (AGs), and no death resulted. Among 418 cases treated with 2 different antibiotics, 241 cases with aminoglycosides (AGs) revealed a case mortality of 22.4%, and remaining 177 cases where AGs was not used showed a rate of 6.8% (P less than 0.05). One hundred and thirty-one cases treated with ABPC with gentamicin gave 29 deaths showing a significantly high mortality of 22.1%. Similar results were obtained for those treated with ABPC with other AGs. Combination of one PCs with another PCs and PCs with CEPs resulted in lower mortalities of 12.5% and 6.1%, respectively and the combination of beta-lactam with non-AGs antibiotics revealed only 4 deaths out of 74 cases, i.e., a case mortality of 5.4%. A gradual decrease of single or combined use of ABPC, mainly with AGs was observed during the survey period and a rapid increase of CEPs V and LMOX therapy occurred after 1982.