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INTRAVENTRICULAR AND OR INTRALUMBAR TREATMENT OF PURULENT MENINGITIS IN INFANTS

Departments of Paediatrics and Bacteriology,University of Leuven. When treated with only intravenous antibiotics, purulent meningitis in infants less than 3 months of age has a fatality rate of 40-70%. This is explained by the delay in the diagnosis, the frequency of ventriculitis, and the low concentrations of antibiotics in the cerebrospinal fluid (CSF).Thirty-nine infants less than 3 months of age were treated with early intrathecal (intraventricular and/or intralumbar) administration of antibiotics. The weight was ≤ 2500 kg in 9 (23%) of them, 17 (43%) were neonates. There were 21 (53%) infections due to gram negative organisms and 9 due to streptococci. Ventriculitis was demonstrated in 21 (53%) cases, and in 82% of the newborns. There were 6 deaths (15%). Sequelae were observed in 8 (20%) of the patients and normal outcome in 25 (65%). Fatality rate was 9.5% and 33% for infections due to gram negative organisms and streptococci respectively; 5/6 deaths occurred in newborns within 36h of treatment, all of them were in severe shock or acidosis on admission. 4/6 of them were treated within 24h after the first symptoms with exchange transfusion and antibiotics. Early diagnosis did not affect the fatality rate in our series but did influence the number of patients with sequelae. Indeed, 6/8 cases with sequelae were treated after a delay of 24h or more after the first symptoms. A scoring system has been developed which enables early prognosis in 87% of the cases.