Abstract

Childhood bacterial meningitis: antimicrobial use pattern and treatment outcomes: a prospective observational study

Author(s): Habtamu Acho Addo*, Sadikalmahdi Hussen & Legese Chelkeba

Background: Bacterial meningitis continues to be an important source of mortality and morbidity in infants and children throughout the world despite advances in antibiotics. Resource limited countries contribute more to the mortality and morbidity. We conducted this study to assess antimicrobial use pattern and determine treatment outcomes among children hospitalized with bacterial meningitis. Study design: Prospective observational study was conducted among infants and children admitted to pediatric ward of Jimma University Specialized Hospital. The data was collected with pretested questionnaire and entered into Epi Data (version 3.1), then exported to SPSS (version 20.0) for analysis. Logistic regression analysis was made to determine independent predictors of poor outcomes. Results: A total of 89 samples of patients which were treated for bacterial meningitis were analyzed. Ampicillin plus Gentamycin was used as initially antibiotic regimen in most young infants (86.8%); while majority of older infants and children (66.7%) initially managed with crystalline penicillin plus Chloramphenicol. Among patients those were treated, 67.4% improved without acute complication, while the remaining 32.6% had poor outcomes (9% died, 18% had delayed fever and 5.6% had acute neurologic complications). Change of antibiotics from empiric therapy was found to be independent predictor of poor outcomes in young infants (AOR= 4.42, 95% CI (1.01-19.44)). However, in older infants and children: irritability (AOR=38.39, 95% CI (1.78-829.36)) and seizure prior to admission (AOR=27.53, 95% CI (1.45-522.35)), initial antibiotic regimen with ceftriaxone plus gentamycin (AOR=66.48, 95% CI (3.16-1400.13)), and missed doses of antibiotics (AOR=47.33, 95% CI (2.14-1046.19)) were found to independently predict poor outcomes. Conclusion: The antimicrobials use pattern in this study was nearly similar with the recommendation of national guideline. At discharge nearly one-fourth of the patients treated for bacterial meningitis experienced poor outcomes implying need revising management protocol of childhood bacterial meningitis.