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Antimicrobial stewardship 

Antimicrobial stewardship
Chapter:
Antimicrobial stewardship
DOI:
10.1093/med/9780198729228.003.0005
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date: 26 June 2019

Bacterial meningitis is a medical emergency and should be considered in all febrile or unwell children, as it requires rapid diagnosis and treatment to avoid the associated poor outcomes. A wide variety of pathogens cause childhood meningitis, and clinical features and outcomes vary according to the organism. Bacterial meningitis caused by Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae type b (Hib) is of particular importance, as it has a high mortality and morbidity, has been relatively common, and is treatable with appropriate antibiotics. Since the 1990s, widespread introduction of highly effective conjugate vaccines against these pathogens in many industrialized countries has led to a significant reduction in the incidence of bacterial meningitis, and viral pathogens now predominate, primarily enteroviruses. There is still a substantial global burden of bacterial meningitis, predominantly occurring in resource-poor countries where case fatality rates are higher and long-term sequelae are commoner. Lumbar puncture is required for a definitive diagnosis of meningitis and should be undertaken before starting antibiotics whenever possible, although treatment should not be delayed if an immediate lumbar puncture is not possible. Children need to be monitored closely throughout the treatment course for the development of complications such as subdural effusions, syndrome of inappropriate antidiuretic hormone secretion, hydrocephalus, and venous sinus thrombosis. All children with bacterial meningitis should have a hearing test soon after hospital discharge, and long-term follow-up is needed to monitor for development of neurological sequelae. Better diagnostic tests and new vaccines are required before this devastating disease can be adequately controlled.

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