Seven versus Ten Days Antibiotics Course for Acute Pyogenic Meningitis in Children: A Randomized Controlled Trial
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ORIGINAL ARTICLE
Seven versus Ten Days Antibiotics Course for Acute Pyogenic Meningitis in Children: A Randomized Controlled Trial N. D. Vaswani 1 & Nishu Gupta 1
&
Ravi Yadav 1 & Anuradha Nadda 2
Received: 11 January 2020 / Accepted: 15 July 2020 # Dr. K C Chaudhuri Foundation 2020
Abstract Objectives To compare the efficacy and safety of 7 d vs. 10 d empirical antibiotic therapy in cases of acute pyogenic meningitis in children aged 3 mo to 14 y with rapid initial recovery. Methods A total of 96 children aged 3 mo to 14 y with acute pyogenic meningitis were randomized to either 7 d or 10 d therapy on Day 5 of the therapy, if they were in clinical remission and had improving cerebrospinal fluid (CSF) abnormalities. The primary outcome was treatment failure in each group within 10 d of enrolment or relapse of meningitis defined as recurrence of signs and symptoms of meningitis within 2 wk of discharge. Secondary outcome was the presence of sequelae in patient at 30 d and 90 d follow-up post discharge. Results Out of 111 screened children, 96 patients completed the trial, 48 in each group. There were 7 treatment failures and relapses each in the group receiving 7 d antibiotics while 6 failures and relapses each were seen in 10 d antibiotics group. There was no statistically significant difference in treatment failure in both the groups [2.1 (-0.12–0.16); p = 0.76]. No deaths or significant adverse effects of the drugs occurred during this study. Four cases of nosocomial sepsis were reported with 2 cases in each group. On subsequent 30 d and 90 d follow-up, no statistically significant difference was found between the two groups regarding frequency of hearing impairment, frequency of hydrocephalus [-2.1 (-0.09–0.13); p = 0.65] and various neurological sequelae [6.2 (−0.06–0.19); p > 0.05]. Conclusions Short course antibiotic therapy may be adequately effective for treatment of acute pyogenic meningitis beyond neonatal age in children with initial rapid recovery. Keywords Acute pyogenic meningitis . Short course antibiotic therapy . Treatment failure . Effectiveness . Safety
Introduction Acute bacterial meningitis (ABM) has a sufficiently high incidence in the pediatric population of developing countries. It can lead to acute complications and is associated with considerable risk of residual neuro-developmental sequelae by causing permanent damage. The exact incidence of ABM in India is not known. In early childhood period, Streptococcus pneumoniae followed by Neisseria meningitides and Hemophilus influenzae b are the commonest causes [1]. According to standard
* Nishu Gupta [email protected] 1
Department of Pediatrics, PGIMS, Rohtak, Haryana, India
2
Department of Community Medicine, PGIMS, Rohtak, Haryana, India
textbooks ABM should be treated with 10–14 d of antibiotics [1] but there are no conclusive guidelines for the duration of treatment of ABM. However, a short antibiotic course, if equally effective, will be a more cost-effective option especially in countries with limited resources. Many
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