A review of acute bacterial meningitis in childhood

Abstract

This paper reviews the epidemiology, pathogenesis and management of acute bacterial meningitis in childhood. The epidemiology of this infection has undergone significant changes with the implementation of effective immunisation, antibiotic therapy and chemoprophylaxis. The reported incidence of bacterial meningitis in children in the Maltese Islands is low compared to other countries. A high index of suspicion is required to diagnose the onset of bacterial meningitis especially in infants. Third-generation cephalosporins are currently the antibiotics of choice for the acute disease. The timely administration of penicillin may be life saving in cases of meningococcal septicaemia. Adjuvant therapy such as dexamethasone may reduce the occurrence and the severity of sequelae, in particular sensorineural hearing loss. Chemoprophylaxis with rifampicin has played an important role in curtailing epidemics of meningococcal disease. The Haemophilus influenzae type b (Hib) vaccine has made a significant impact on the incidence of H. influenzae meningitis in children. Effective vaccines against pneumococci and meningococci (type b) do not yet exist, however ongoing research seeks to produce these vaccines in an effort to emulate the successful outcome attained by the Hib vaccine.