bacterialmeningitis-資料下載頁
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【正文】 erage as noted below ? Children under age 3 months ? Cefotaxime and ampicillin ? Ceftriaxone and ampicillin (children over age 1months) ? Children over 3 months ? Cefotaxime or Ceftriaxone or ampicillin and chloramphenicol Antibiotic Therapy ? Certainly Bacterium ? Once the pathogen has been identified and the antibiotic sensitivities determined, the most appropriate drugs should selected. ? N meningitidis : penicillin, tert cephalosporin ? S pneumoniae: penicillin, tert cephalosporin, vanycin ? H influenzae: ampicillin, tert cephalosporin ? S aureus: penicillin, nefcillin, vanycin ? E coli: ampicillin, chloramphenicol, tert cephalosporin Antibiotic Therapy ? Course of treatment ? 7 days for meningococcal infection ? 10～ 14 days for H influenzae or S pneumoniae infection ? More than 21 days for S aureus or E coli infection ? 14～ 21 days for other anisms Treatment General and Supportive Measures ? Monitor of vital sign ? Correcting metabolic imbalances ? Supplying sufficient heat quantity ? Correcting hypoglycemia ? Correcting metabolic acidemia ? Correcting fluids and electrolytes disorder ? Application of cortical hormone ? Lessening inflammatory reaction ? Lessening toxic symptom ? lessening cerebral edema General and Supportive Measures ? Treatment of hyperpyrexia and seizures ? Pyretolysis by physiotherapy and/or drug ? Convulsive management ? Diazepam ? Phenobarbital ? Subhibernation therapy ? Treatment of increased intracranial pressure ? Dehydration therapy ? 20%Mannitol 5ml/kg vi q6h ? Lasix 12mg/kg vi General and Supportive Measures ? Treatment of septic shock and DIC ?Volume expansion ?Dopamine ?Corticosteroids ?Heparin ?Fresh frozen plasma ?Platelet transfusions Treatment Complication Measures ? Subdural effusions ? Subduaral pricking ? Drawoff effusions on one side is 2030ml/time. ? Once daily or every other day is requested. ? Time cell of pricking may be prolonged after 2 weeks. ? Ependymitis ? Ventricular puncture — drainage ? Pressure in ventricle be depressed. ? Ventricular puncture may give ventricle an injection of antibiotic. Complication Measures ? Hydrocephalus ? Operative treatment ? Adhesiolysis ? Bypass operation of cerebrospinal fluid ? Dilatation of aqueduct ? SIADH (Cerebral hyponatremia) ? Restriction of fluid ? supplement of serum sodium ? diuretic Prognosis ? Appropriate antibiotic therapy reduces the mortality rate for bacterial meningitis in children, but mortality remain high. ? Overall mortality in the developed countries ranges between 5% and 30%. ? 50 percent of the survivors have some sequelae of the disease. Prognosis ? Prognosis depends upon many factors: ? Age ? Causative anism ? Number of anisms and bacterial virulence ? Duration of illness prior to effective antibiotic therapy ? Presence of disorders that may promise host response to infection
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