Effect of Antibiotic Pretreatment on Cerebrospinal Fluid Profiles of Children With Bacterial Meningitis
Partially treated meningitis
Many children receive antibiotics before definitive diagnosis is made. As a rule, a few doses of oral antimicrobial agents, or even a single injection of an antibiotic, do not significantly alter CSF findings, including bacterial cultures, especially in patients with H influenzae type b (Hib) disease. Oral antibiotics have never convincingly been shown to render patients with bacterial meningitis CSF culture–negative.
CSF cultures may become sterile rapidly if the pathogen was a pneumococcus or meningococcus, though cellular changes, an increase in protein, and low glucose levels persist. In such cases, CSF, blood, and urine should be tested for bacterial antigens; however, the presence of a negative antigen result does not entirely rule out a bacterial source.
In cases where antibiotic administration leads to CSF sterilization, polymerase chain reaction (PCR) testing may have a role to play in identifying the pathogen. PCR testing is able to identify the pathogen quickly and accurately and does not require a large number of organisms; however, it does require further validation in this setting.
Nigrovic et al found that Gram stain results (WBC count and absolute neutrophil count) in CSF were not affected by pretreatment with antibiotics; however, the rates of positive CSF culture and blood culture were lower with antibiotic pretreatment. After pretreatment with antibiotics for 12 hours or longer, the patients had higher CSF glucose levels and lower CSF protein levels.
For details click at
For study conducted by Nigrovic et at, login at
Thank you Sir
ReplyDeleteGreat sir
ReplyDeleteThank you sir
ReplyDelete