Heikki Peltola

RANDOMISED COMPARISON OF CHLORAMPHENICOL, AMPICILLIN, CEFOTAXIME, AND CEFTRIAXONE FOR CHILDHOOD BACTERIAL MENINGITIS

In a multicentre study, 220 consecutive cases of bacterial meningitis in children older than 3 months were randomised to treatment with chloramphenicol, ampicillin (initially with chloramphenicol), cefotaxime, or ceftriaxone. The drugs were given in four equal daily doses for 7 days, except ceftriaxone which was given only once daily. 200 cases could be assessed; the causative organisms were Haemophilus influenzae type b (Hib) in 146; meningococci (Mnc) in 32; pneumococci (Pnc) in 13; and other or unknown in 9. In patients with Hib meningitis, sterilisation of the cerebrospinal fluid occurred most rapidly with ceftriaxone. Otherwise, in terms of overall clinical recovery, normalisation of laboratory indices, clinically significant adverse reactions, toxic effects, sequelae, and mortality rate, the treatment groups were very similar. However, there were 4 bacteriological failures, all in the chloramphenicol group. Also, the treatment was extended or changed in more cases in the chloramphenicol group than in the other groups. Chloramphenicol was thus inferior to the other three antimicrobials. Ampicillin is a good and cheap alternative, but there are difficulties with resistance. Easy administration tempts the use of ceftriaxone rather than cefotaxime but it causes diarrhoea. A 7-day course of ampicillin, cefotaxime, or ceftriaxone is sufficient in Hib, Mnc, or Pnc meningitis.

Disappearance of epiglottitis during large-scale vaccination with Haemophilus influenzae type B conjugate vaccine among children in Finland

Surveillance of blood‐culture‐proven epiglottitis was conducted in Finland from 1985 through 1992. Among children (<16 years), all bacteria causing epiglottitis, and among adults, Haemophilus influenzae were included. H influenzae type b (Hib) caused 226 (97%) of cases among children. Among adults with H influenzae epiglottitis (total of 20), 19 were caused by Hib

Incidence of Haemophilus influenzae type b meningitis during 18 years of vaccine use: observational study using routine hospital data

Despite the spectacular success of Haemophilus influenzae type b (Hib) conjugate vaccines in the developed world,1 failures have become more common in the Netherlands and the United Kingdom, where the incidence of invasive Hib diseases at age 0-4 years per 100 000 increased from 0.66 in 1998 to 2.96 in 2001.2 An immunological defect is not to blame. This increase in failure coincided with the change from whole cell pertussis to combined three component acellular vaccine (DTaP-Hib). This combination lowers Hib antibodies.3 The clinical significance is unclear. Acellular vaccine cannot be blamed in the Netherlands, where whole cell vaccine was still used.4 Both countries have been giving Hib vaccination at age 2, 3, and 4 months; a booster at 11 months is given in the Netherlands. Another characteristic in the United Kingdom is concomitant meningococcal group C conjugate. Replacement of serotypes other than Hib in severe diseases has also raised concern. Because H influenzae meningitis in the Greater …