Response to antimicrobial therapy in childhood bacterial meningitis in tropical Africa: report of a bi-centre experience in Nigeria, 1993-1998

Recent reports of a high prevalence of in-vitro resistance to chloramphenicol (CHL) and penicillin (PEN)/ampicillin (AMF) cause concern because of cost implications in using the newer cephalosporins (CEPH) to treat meningitis in resource-poor countries.]However, the clinical significance of many of the observations is uncertain because of limited back-up by clinical data. We analysed the response in an open study of 161 patients with bacterial meningitis treated with CHL (n = 31), CHL plus PEN or AMP (n = 101), PEN or AMP (n = 14) and CEPH (n = 15). No significant differences were observed in clinical course and outcome in the four treatment groups, other than a higher prevalence of seizures after 72 h of treatment and a higher prevalence of neurological sequelae in survivors in the CEPH and CHL groups. This may reflect the higher number of infants and greater frequencies of uncommon aetiological agents in the CHL and CEPH groups. It is concluded that response to initial chloramphenicol-based treatment regimens remains satisfactory and that there is as yet no compelling reason to switch to the cephalosporins as first-line therapy for bacterial meningitis in developing countries.