Abstract

ALVAREZ PINZON, ANDRÉS MAURICIO; RODRIGUEZ MARTINEZ, MAYERLI  and  CHARRIA ORTIZ, GUSTAVO. NEONATAL BACTERIAL MENINGITIS TREATMENT UPDATE AND REPORT OF A CASE. rev.fac.med [online]. 2010, vol.18, n.1, pp.100-114. ISSN 0121-5256.

Neonatal bacterial meningitis is one of the infectious diseases most commonly associated with high rates of morbidity and mortality in affected individuals. Although this entity is present worldwide, its incidence and prevalence are much higher in developing countries due to the lack of adequate prenatal care, which constitutes one of the associated factors. During the last decade more effective antibacterial agents have enabled remarkable advances in treatment of this pathology, helping to minimize the severity of the clinical and/or its consequences and hence aiding to achieve a better prognosis and a decrease in the associated mortality. However, this pathology is still common; suggesting that the key to a good prognosis relies in its prevention, which in turns requires early detection and treatment of the infectious agent together with a good clinical diagnosis and confirmation by paraclinical studies, all of these will allow the selection of adequate treatment. The main causative agents remain: the Streptococcus agalactiae (Group B), gram negative bacilli, Listeria monocytogenes and Streptococcus pneumoniae; and the risk factorsare are: preterm birth (<37 weeks), premature rupture of membranes more than 18 hours, or a maternal temperature greater or equal to 38 °C at the time of delivery. Although the final management should focus on the outcome of susceptibility in samples of blood cultures, empiric treatment with penicillin plus a third-generation cephalosporin or an aminoglycoside gentamicin type, preferably after samples are taken, have shown better clinical responses. The intravenous therapy of the appropriate antibiotic should be applied until two weeks after culture negativization. Unfortunately, even in cases with early and adequate treatment, the severe long-term sequelae are not uncommon (12% to 29% of patients), although these have been associated mostly with the Group B Streptococcus and the gram negative bacilli.

Keywords : meningitis; neonate; Streptococcus agalactiae; Listeria monocytogenes; Streptococcus pneumoniae.

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