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Basatemur E. Bacterial meningitis in children. BMJ 2023; 381:728. [PMID: 37225238 DOI: 10.1136/bmj.p728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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van de Beek D, Cabellos C, Dzupova O, Esposito S, Klein M, Kloek AT, Leib SL, Mourvillier B, Ostergaard C, Pagliano P, Pfister HW, Read RC, Sipahi OR, Brouwer MC. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect 2016; 22 Suppl 3:S37-62. [PMID: 27062097 DOI: 10.1016/j.cmi.2016.01.007] [Citation(s) in RCA: 442] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/11/2016] [Indexed: 12/18/2022]
Affiliation(s)
- D van de Beek
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - C Cabellos
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - O Dzupova
- Department of Infectious Diseases, Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - S Esposito
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - M Klein
- Department of Neurology, Klinikum Großhadern, Munich, Germany
| | - A T Kloek
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - S L Leib
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - B Mourvillier
- Department of Intensive Care Medicine, Groupe Hospitalier Bichat-Claude Bernard, Paris, France
| | - C Ostergaard
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - P Pagliano
- Department of Infectious Diseases, "D. Cotugno" Hospital, Naples, Italy
| | - H W Pfister
- Department of Neurology, Klinikum Großhadern, Munich, Germany
| | - R C Read
- Department of Infectious Diseases, Southampton General Hospital, Southampton, United Kingdom
| | - O Resat Sipahi
- Department of Infectious Diseases and Clinical Microbiology, Ege University, Izmir, Turkey
| | - M C Brouwer
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
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Elenga N, Sicard S, Cuadro-Alvarez E, Long L, Njuieyon F, Martin E, Kom-Tchameni R, Balcaen J, Moreau B, Boukhari R. Pediatric bacterial meningitis in French Guiana. Med Mal Infect 2015; 45:441-5. [PMID: 26607229 DOI: 10.1016/j.medmal.2015.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/29/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Controlling vaccine-preventable infectious diseases is a public health priority in French Guiana but there is currently no epidemiological data on pediatric bacterial meningitis in this overseas department. Our aim was to describe data related to pediatric bacterial meningitis in French Guiana and compare it with that of metropolitan France. METHODS We conducted a multicenter retrospective study from 2000 to 2010 to describe the clinical picture, biological data, epidemiology, and outcome of pediatric bacterial meningitis case patients in French Guiana. RESULTS The median age of bacterial meningitis patients was 6months [0-15] and the sex ratio 1.06. We observed a total of 60 bacterial meningitis case patients. Most presented with pneumococcal meningitis (24 patients; 40%); 11 with Haemophilus influenzae type b meningitis (23%), five with group B streptococcal meningitis (8.5%), and five others (8.5%) with staphylococcal meningitis (three patients presented with coagulase-negative staphylococci and two with Staphylococcus aureus). Only one patient presented with group B meningococcal meningitis, an 18-month-old infant. We recorded 14 deaths (overall case fatality: 23%); eight were due to Streptococcus pneumoniae (case fatality: 33%). The overall sequelae rate was 28%. It was 32% for patients presenting with pneumococcal meningitis. We observed that 38% of children who had never been vaccinated were infected by a vaccine-preventable bacterium. We observed many differences in the distribution of the bacteria and in the patients' prognosis when comparing the French Guiana data with that of metropolitan France. CONCLUSION Improving vaccination coverage would decrease the incidence of H. influenzae meningitis.
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Affiliation(s)
- N Elenga
- Service de pédiatrie, centre hospitalier de Cayenne « Andrée-Rosemon », rue des Flamboyants, BP 6006, 97306 Cayenne cedex, French Guiana.
| | - S Sicard
- Service de pédiatrie, centre hospitalier de Cayenne « Andrée-Rosemon », rue des Flamboyants, BP 6006, 97306 Cayenne cedex, French Guiana
| | - E Cuadro-Alvarez
- Service de pédiatrie, centre hospitalier de Cayenne « Andrée-Rosemon », rue des Flamboyants, BP 6006, 97306 Cayenne cedex, French Guiana
| | - L Long
- Service de pédiatrie, centre hospitalier de Cayenne « Andrée-Rosemon », rue des Flamboyants, BP 6006, 97306 Cayenne cedex, French Guiana
| | - F Njuieyon
- Service de pédiatrie, centre hospitalier de Cayenne « Andrée-Rosemon », rue des Flamboyants, BP 6006, 97306 Cayenne cedex, French Guiana
| | - E Martin
- Service de pédiatrie, centre hospitalier de Cayenne « Andrée-Rosemon », rue des Flamboyants, BP 6006, 97306 Cayenne cedex, French Guiana
| | - R Kom-Tchameni
- Service de pédiatrie, centre hospitalier de Cayenne « Andrée-Rosemon », rue des Flamboyants, BP 6006, 97306 Cayenne cedex, French Guiana
| | - J Balcaen
- Service de pédiatrie, centre hospitalier de Cayenne « Andrée-Rosemon », rue des Flamboyants, BP 6006, 97306 Cayenne cedex, French Guiana
| | - B Moreau
- Laboratoire de bactériologie, centre hospitalier de Cayenne « Andrée-Rosemon », rue des Flamboyants, BP 6006, 97306 Cayenne cedex, French Guiana
| | - R Boukhari
- Laboratoire de biologie médicale, centre hospitalier de l'Ouest Guyane « Franck-Joly », 16, boulevard du Général-de-Gaulle, BP 245, 97393 Saint-Laurent-du-Maroni cedex, French Guiana
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Childhood meningitis caused by Streptococcus bovis group: clinical and biologic data during a 12-year period in France. Pediatr Infect Dis J 2015; 34:136-9. [PMID: 25144798 DOI: 10.1097/inf.0000000000000513] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bacterial meningitis (BM) is a major cause of morbidity and mortality in children. Sporadic cases of Streptococcus bovis have been described in neonates and infants. To assess the epidemiologic, clinical and biologic characteristics of this meningitis, we used the French Surveillance Network for BM in children. METHODS Two hundred and twenty-seven pediatric wards working with 168 microbiology departments throughout France were asked to report all cases of BM in patients <18 years. Diagnosis was based on a combination of fever, meningeal signs and a positive cerebrospinal fluid (CSF) culture and/or a positive polymerase chain reaction in the CSF and/or positive blood culture associated with pleiocytosis. RESULTS Among 4806 cases of BM recorded in 12 years (2001-2012), 23 cases were caused by S. bovis (0.5%). All were infants. Among them, 15 cases (65.2%) occurred in the neonatal period. The majority occurred in premature infants (73.9%). In 21 cases, the diagnosis was based on a positive CSF culture. Blood culture was positive in 17 children. When S. bovis subtype was identified, it was type 2 (Streptococcus gallolyticus pasteurianus) in 80% of cases. All infants received antibiotic therapy with parenteral penicillin and/or third-generation cephalosporin combined with an aminoglycoside. The duration of treatment ranged from 10 to 25 days. Of the 23 patients, 17 (73.9%) had a second lumbar puncture and in all those cases, the CSF was sterile. No deaths or neurologic complications were reported. CONCLUSION BM due to S. bovis is rare and primarily affects infants, particularly premature infants. Antibiotic treatment is effective with low morbidity and mortality.
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Trends of pneumococcal meningitis in children after introduction of the 13-valent pneumococcal conjugate vaccine in France. Pediatr Infect Dis J 2014; 33:1216-21. [PMID: 25037044 DOI: 10.1097/inf.0000000000000451] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Streptococcus pneumoniae remains an important cause of bacterial meningitis in children younger than 2 years. Here, we analyzed data from an active surveillance network established 12 years ago by the Pediatric Infectious Disease Group and the Pediatric Clinical and Therapeutical Association to analyze the impact of pneumococcal conjugate vaccine (PCV7 implemented in 2002 and PCV13 in 2010) on pneumococcal meningitis (PM). METHODS Two hundred twenty-seven pediatric wards working with 168 microbiology departments throughout France were asked to report all cases of PM. RESULTS From 2001 to 2012, among 4808 bacterial meningitis cases, 1406 cases of PM (29.2%) were reported. After PCV13 implementation, from 2009 to 2012, the number of cases significantly decreased by 27.4% (P = 0.041, Cuzick trend test). For children younger than 2 years, the decrease was 28.2% (P = 0.039, Cuzick trend test). In the same period, the decrease was 66.7% in cases due to 6 additional PCV13 types, and the number of cases due to nonvaccine types remained stable. In 2012, the non-PCV13 serotype represented 67.6% of cases and were mainly represented by 12F (15%), 24F (15%), 22F (7%) and 15B/C (7%). For 88.6% of cases, initial antibiotic treatment was vancomycin with a third-generation cephalosporin. Overall mortality was 10.6%, most deaths (86.4%) occurred before day 15. CONCLUSIONS Two years after the PCV13 implementation, we found an impact on PM cases particularly for children younger than 2 years.
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Levy C, Varon E, Taha MK, Béchet S, Bonacorsi S, Cohen R, Bingen E. Évolution des méningites bactériennes de l’enfant en France sous l’effet des vaccinations. Arch Pediatr 2014; 21:736-44. [DOI: 10.1016/j.arcped.2014.04.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/17/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
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Casasoprana A, Hachon Le Camus C, Claudet I, Grouteau E, Chaix Y, Cances C, Karsenty C, Cheuret E. Utilité de la ponction lombaire lors de la première convulsion fébrile chez l’enfant de moins de 18 mois. Étude rétrospective de 157 cas. Arch Pediatr 2013; 20:594-600. [DOI: 10.1016/j.arcped.2013.03.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 02/07/2013] [Accepted: 03/12/2013] [Indexed: 11/30/2022]
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Águeda S, Campos T, Maia A. Prediction of bacterial meningitis based on cerebrospinal fluid pleocytosis in children. Braz J Infect Dis 2013; 17:401-4. [PMID: 23602468 PMCID: PMC9428050 DOI: 10.1016/j.bjid.2012.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 12/10/2012] [Indexed: 10/26/2022] Open
Abstract
Children with cerebrospinal fluid pleocytosis are frequently treated with parenteral antibiotics, but only a few have bacterial meningitis. Although some clinical prediction rules, such as bacterial meningitis score, are of well-known value, the cerebrospinal fluid white blood cells count can be the initial available information. Our aim was to establish a cutoff point of cerebrospinal fluid white blood cell count that could distinguish bacterial from viral and aseptic meningitis. A retrospective study of children aged 29 days to 17 years who were admitted between January 1st and December 31th, 2009, with cerebrospinal fluid pleocytosis (white blood cell≥7μL(-1)) was conducted. The cases of traumatic lumbar puncture and of antibiotic treatment before lumbar puncture were excluded. There were 295 patients with cerebrospinal fluid pleocytosis, 60.3% females, medium age 5.0±4.3 years distributed as: 12.2% 1-3 months; 10.5% 3-12 months; 29.8% 12 months to 5 years; 47.5% >5 years. Thirty one children (10.5%) were diagnosed with bacterial meningitis, 156 (52.9%) viral meningitis and 108 (36.6%) aseptic meningitis. Bacterial meningitis was caused by Neisseria meningitidis (48.4%), Streptococcus pneumoniae (32.3%), other Streptococcus species (9.7%), and other agents (9.7%). cerebrospinal fluid white blood cell count was significantly higher in patients with bacterial meningitis (mean, 4839cells/μL) compared to patients with aseptic meningitis (mean, 159cells/μL, p<0.001), with those with aseptic meningitis (mean, 577cells/μL, p<0.001) and with all non-bacterial meningitis cases together (p<0.001). A cutoff value of 321white blood cell/μL showed the best combination of sensitivity (80.6%) and specificity (81.4%) for the diagnosis of bacterial meningitis (area under receiver operating characteristic curve 0.837). Therefore, the value of cerebrospinal fluid white blood cell count was found to be a useful and rapid diagnostic test to distinguish between bacterial and nonbacterial meningitis in children.
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Affiliation(s)
- Sofia Águeda
- Department of Pediatrics, Centro Hospitalar São João, EPE, Porto, Portugal.
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Meningiti acute. Neurologia 2013. [DOI: 10.1016/s1634-7072(13)64518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Charfi F, Smaoui H, Kechrid A. Non-susceptibility trends and serotype coverage by conjugate pneumococcal vaccines in a Tunisian paediatric population: A 10-year study. Vaccine 2012; 30 Suppl 6:G18-24. [DOI: 10.1016/j.vaccine.2012.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Factors influencing neurological outcome of children with bacterial meningitis at the emergency department. Eur J Pediatr 2012; 171:1365-71. [PMID: 22527566 DOI: 10.1007/s00431-012-1733-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 03/28/2012] [Indexed: 10/28/2022]
Abstract
We performed a cohort study of children who survived bacterial meningitis after the neonatal period at a single pediatric center in France over a 10-year period (1995-2004) to identify predictors of death and long-term neurological deficits in children with bacterial meningitis. We performed multivariate regression to determine independent predictors of death and neurologic deficits. We identified 101 children with bacterial meningitis of which 19 died during initial hospitalization. Need for mechanical ventilation [hazard ratio (HR) 11.5, 95 % confidence interval (CI) 2.4-55.5)] and thrombocytopenia defined as a platelet count <150 × 10(9) per liter (HR 0.6, 95 % CI 0.4-0.9) at presentation were associated with death during initial hospitalization. At final assessment, 42 of the 70 survivors had no neurologic deficits identified; 20 had a single deficit, and eight had multiple deficits. A delay in initiation of antibiotics (HR 1.3, 95 % CI 1.1-1.7) and hydrocephalus on computed tomographic scan (HR 2.6, 95 % CI 1.1-6.0) were associated with having one or more long-term neurologic deficits. Identification of children at risk of death or long-term neurologic sequelae may allow therapeutic interventions to be directed to children at the highest risk.
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Klena JD, Wasfy MO, Nada RA, Ahmed SF, Maksoud MA, Marfin A, Pimentel G. Characterization of Neisseria meningitidis isolates from Egypt using multilocus sequence typing. Trans R Soc Trop Med Hyg 2012; 106:309-14. [PMID: 22405492 DOI: 10.1016/j.trstmh.2012.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 01/23/2012] [Accepted: 01/23/2012] [Indexed: 10/28/2022] Open
Abstract
To characterize Neisseria meningitidis isolates collected from cerebrospinal fluid of meningitis cases in Egypt (1998-2003) as part of surveillance studies, 67 isolates were serogrouped, tested for antibiotic sensitivity and analyzed using multilocus sequence typing (MLST). Results show that isolates expressing serogroup B (50.7%) and serogroup A (34.3%) antigens were predominant in Egypt during the surveillance period, possibly due to suppression of other serogroups by meningococcal vaccines in current use. Intermediate resistance to penicillin was observed in 71% of the isolates, suggesting a need for physicians to shift to third-generation cephalosporins during the empirical treatment of infection. Recurrent lineages of N. meningitidis in Egypt appear to originate from Europe and other Middle Eastern countries. Of 19 sequence types detected, five were unique to Africa and 10 were not observed previously in the MLST database. The information obtained illustrates the changing dynamics of meningitis after vaccine introduction in Egypt.
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Affiliation(s)
- John D Klena
- US Naval Medical Research Unit No. 3, Cairo, Egypt.
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Heath PT, Okike IO, Oeser C. Neonatal meningitis: can we do better? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 719:11-24. [PMID: 22125031 DOI: 10.1007/978-1-4614-0204-6_2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Paul T Heath
- Child Health and Vaccine Institute, St Georges, University of London, London, UK.
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Association of meningococcal phenotypes and genotypes with clinical characteristics and mortality of meningitis in children. Pediatr Infect Dis J 2010; 29:618-23. [PMID: 20168263 DOI: 10.1097/inf.0b013e3181d3ce32] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neisseria meningitidis meningitis represents approximately one-half of the meningococcal cases in French children. To explore the contribution of bacterial typing in improving the management of cases, we aimed to describe clinical characteristics and mortality of meningococcal meningitis in children reported to the multicenter survey system, GPIP/ACTIV, in association with phenotypes/genotypes of bacterial isolates. METHODS From 2001 to 2005, 259 pediatric wards and 168 microbiology laboratories enrolled all children with bacterial meningitis. Risk factors, vaccination status, signs and symptoms, cerebrospinal fluid analysis, treatments and case fatality rate were recorded. RESULTS A total of 962 cases of Neisseria meningitidis meningitis among a total of 2131 bacterial meningitis (45%) were recorded (mean age, 4.5 +/- 4.7 years). Serogroup distribution of the isolates was 62.3%, 33.7%, 2.9%, 0.6%, and 0.6% for serogroups B, C, W135, A and Y, respectively. The major clonal complexes were ST-41/44 (32.2%), ST-11 (21.9%), ST-32 (20.8%), ST-8 (8.2%), and ST-269 (4.9%). Despite global heterogeneity of the isolates, 2 phenotypes/genotypes were of interest. Isolates of the phenotype/genotype B:14:P1.7,16/ST-32 (56% clustered in the region of Haute Normandie) were observed in older children (8.6 years) and were associated with a higher case fatality rate (12%) than were other phenotypes of serogroup B. The phenotype/genotype C:2a:P1.5/ST-11 was found in 26.3% of serogroup C cases and was possibly associated with a higher mortality among serogroup C (9.9% for C and 5.9% for B, P = 0.04). CONCLUSIONS This large survey provides data that could be important for implementation of future vaccines. Typing of meningococcal isolates could contribute to an understanding of prognosis in meningococcal meningitis.
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Sarlangue J, Castella C, Lehours P. [First and second line antibiotic therapy for bacterial meningitis in infants and children]. Med Mal Infect 2009; 39:521-30. [PMID: 19409744 DOI: 10.1016/j.medmal.2009.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 12/25/2022]
Abstract
The potential severity of meningitis in infants and children requires an optimized initial empirical therapy, mainly based on direct cerebro spinal fluid (CSF) examination, and rapid therapeutic adaptation according to bacterial identification and susceptibility. Combination treatment including cefotaxim (300 mg/kg per day) or ceftriaxone (100mg/kg per day) and vancomycine (60 mg/kg per day) remains the standard first line if pneumococcal meningitis cannot be ruled out. A simple treatment with third generation cephalosporin can be used for Neisseria meningitidis or Haemophilus influenzae meningitis, aminoglycosides must be added in case of Enterobacteriacae, mainly before 3 months of age. Second line antibiotic therapy is adapted according to the clinical and bacteriological response on Day 2. When the minimal inhibitory concentration (MIC) of pneumococcal strain is less than 0.5mg/L, third generation cephalosporin should be continued alone for a total of 10 days. In other cases, a second lumbar puncture is necessary and the initial regimen, with or without rifampicin combination, should be used for 14 days. Amoxicillin during 3 weeks, associated with gentamycin or cotrimoxazole is recommended for listeriosis.
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Affiliation(s)
- J Sarlangue
- Département de pédiatrie médicale, hôpital des Enfants, CHU de Bordeaux, place A.-Raba-Léon, 33076 Bordeaux cedex, France.
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