rifampin and Meningitis--Bacterial

Haemophilus influenzae remains a common cause of illness in children throughout the world. Before the introduction of vaccination, H influenzae type b (Hib) disease was the leading cause of bacterial meningitis in young children and a frequent cause of pneumonia, epiglottitis, and septic arthritis. Clinicians should remain diligent in counseling parents on the dangers of Hib and provide vaccination starting at 2 months of age. The epidemiology of invasive H influenzae disease is shifting. It is imperative that clinicians recognize the changing epidemiology and antibiotic resistance patterns for H influenzae to optimize care in hospital and ambulatory settings.

Topics: Anti-Bacterial Agents; Bacteremia; Cephalosporins; Child; Child, Preschool; Female; Haemophilus Infections; Haemophilus influenzae type b; Humans; Incidence; Infant; Male; Meningitis, Bacterial; Pneumonia; Post-Exposure Prophylaxis; Rifampin; Vaccination

Elizabethkingia meningoseptica, a Gram-negative pathogen once deemed clinically insignificant, tends to cause infections among low-birth-weight infants and immunocompromised patients. Previously, vancomycin was reported to cure several patients with bacteraemia caused by E. meningoseptica. Nevertheless, some laboratory investigations also showed considerable discordance between in vitro vancomycin susceptibility results obtained by the disk diffusion and broth microdilution methods against clinical E. meningoseptica isolates as determined using the criteria for staphylococci recommended by the Clinical and Laboratory Standards Institute (CLSI). In this review, the PubMed database (1960-2017) was searched for studies that reported mainly cases with E. meningoseptica bacteraemia or meningitis treated with vancomycin alone or with regimens that included vancomycin. In addition, the in vitro synergy between vancomycin and other agents against isolates of E. meningoseptica was reviewed. Elizabethkingia meningoseptica bacteraemia appears not to universally respond to intravenous (i.v.) vancomycin-only therapy, especially in patients who require haemodialysis. If i.v. vancomycin is the favoured therapy against E. meningoseptica meningitis, the addition of ciprofloxacin, linezolid or rifampicin might be an option to effectively treat this difficult-to-treat infection. Further clinical studies are needed to determine the clinical efficacy of these combination regimens for the treatment of E. meningoseptica meningitis.

Topics: Anti-Bacterial Agents; Bacteremia; Ciprofloxacin; Disk Diffusion Antimicrobial Tests; Drug Synergism; Drug Therapy, Combination; Flavobacteriaceae; Flavobacteriaceae Infections; Humans; Immunocompromised Host; Infant, Low Birth Weight; Infant, Newborn; Linezolid; Meningitis, Bacterial; Rifampin; Treatment Outcome; Vancomycin

Bacterial meningitis remains a dangerous disease with frequent complications despite specific antibiotic therapy and intensive medical supportive treatment. Principal symptoms are headaches, high fever, meningismus and confusion or drowsiness that usually develop within a few hours. The diagnosis is mainly based on the examination of the cerebrospinal fluid and detection of the pathogen in the liquor or blood. Implementation of an early, empirical antibiotic therapy is important for the prognosis; community-acquired meningitides in adults should be treated with ceftriaxone and ampicillin. For infections with meningococci, the public health authorities must be also informed and chemoprophylaxis with rifampicin, ciprofloxacin or ceftriaxone for close contacts should be carried out.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Ciprofloxacin; Community-Acquired Infections; Critical Care; Enzyme Inhibitors; Hospitalization; Humans; Meningitis, Bacterial; Neisseria meningitidis; Prognosis; Rifampin; Streptococcus pneumoniae; Tomography, X-Ray Computed

Antimicrobial resistance has emerged among the three major bacterial pathogens causing meningitis. Chloramphenicol resistance in the meningococcus recently has been described, and although intermediate penicillin resistance is common in some countries, the clinical importance of penicillin resistance in the meningococcus has yet to be established. Beta-lactamase-producing Haemophilus influenzae are relatively common, and chloramphenicol resistance is emerging. Third-generation cephalosporins are required to treat meningitis caused by these resistant strains. Pneumococcus resistance to penicillin and to chloramphenicol is widespread, and resistance to third-generation cephalosporins is found in many parts of the world. Correct management of these strains includes the addition of vancomycin or rifampin to therapy with third-generation cephalosporins.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Cephalosporins; Chloramphenicol; Drug Resistance, Microbial; Fluoroquinolones; Haemophilus influenzae; Humans; Meningitis, Bacterial; Neisseria meningitidis; Penicillins; Rifampin; Streptococcus pneumoniae; Vancomycin

Flavobacterium meningosepticum is an unusual, highly resistant, gram-negative bacillus that is associated with neonatal meningitis and nursery outbreaks of meningitis. The optimal therapy for this infection is not known. We successfully treated three neonates with intravenous vancomycin and rifampin. We determined the in vitro activity of meropenem, ciprofloxacin, vancomycin, linezolid (PNU-100766), and rifampin, alone and in combination, against four isolates of F. meningosepticum from neonates with sepsis and meningitis. MICs were determined by tube dilution, and fractional inhibitory concentrations were calculated with use of the checkerboard microtiter dilution technique. Synergy was observed between rifampin and vancomycin against three isolates, while combinations of vancomycin, ciprofloxacin, and linezolid showed an additive effect against all isolates. These results support the clinical evidence that the combination of vancomycin and rifampin is an appropriate regimen for neonatal meningitis due to F. meningosepticum. The combination of meropenem and vancomycin was antagonistic. The clinical efficacy of combinations including ciprofloxacin, newer quinolones, or linezolid for treating F. meningosepticum meningitis deserves further study.

Topics: Drug Synergism; Drug Therapy, Combination; Female; Flavobacterium; Gram-Negative Bacterial Infections; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Rifampin; Vancomycin

Chryseobacterium meningosepticum is a ubiquitous Gram-negative bacillus historically associated with meningitis in premature neonates. We report 15 positive cultures and 6 cases of infection among immunocompromised adults at our institution over a 10-year period and review the English-language literature on C. meningosepticum. Excluding the present series, there are 308 reports of positive cultures in the literature, of which 59% were determined to represent true infections. Sixty-five percent of those infected were younger than 3 months of age. Meningitis was the most common infectious syndrome among neonates, seen in 84% of cases and associated with a 57% mortality rate. Less commonly reported infections among infants included sepsis (13%) and pneumonia (3%). Pneumonia was the most frequent infection among the postneonatal group, accounting for 40% of cases, followed by sepsis (24%), meningitis (18%), endocarditis (3%), cellulitis (3%), abdominal infections (3%), eye infections (3%), and single case reports of sinusitis, bronchitis, and epididymitis. The 6 cases in our series were all adults, with a mean age of 58.7 years. Sites of C. meningosepticum infection were limited to the lungs, bloodstream, and biliary tree. Infection in our series was associated with prolonged hospitalization, prior exposure to multiple antibiotics, and host immunocompromise, particularly neutropenia. C. meningosepticum is resistant to multiple antibiotics, and disk dilution is notoriously unreliable for antibiotic sensitivity testing. Sensitivity testing on the 15 isolates from our institution revealed the most efficacious antibiotics to be minocycline (100% sensitive), rifampin (93%), trimethoprim-sulfamethoxazole (67%), and ciprofloxacin (53%). In contrast to reports in the literature, the isolates in our series displayed widespread resistance to vancomycin (100% resistant or intermediately sensitive), erythromycin (100%), and clindamycin (86%). These findings have important implications for the clinician when choosing empiric antibiotic regimens for patients with risk factors for C. meningosepticum infection.

Topics: Adult; Aged; Anti-Bacterial Agents; Antibiotics, Antitubercular; Breast Neoplasms; Ciprofloxacin; Drug Resistance, Microbial; Female; Flavobacterium; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Infant; Infant, Newborn; Leukemia, Myeloid, Acute; Liver Transplantation; Male; Meningitis, Bacterial; Middle Aged; Minocycline; Pneumonia, Bacterial; Rifampin; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination

Bacterial meningitis caused by Streptococcus pneumoniae is an important cause of neurological morbidity and mortality in both children and adults. With increasing antibiotic resistance in pneumococci and documented microbiological failure in treatment of pneumococcal meningitis with cefotaxime and ceftriaxone, the need for alternative antibiotic therapy is critical. Of the currently available options, vancomycin has shown the most promise, particularly when used in combination with ceftriaxone or cefotaxime. Rifampin, also used in combination with either ceftriaxone or cefotaxime, has demonstrated encouraging preliminary results against antibiotic-resistant pneumococci as well. Chloramphenicol has unexpectedly yielded discouraging clinical results in children with infection caused by penicillin-resistant strains. Of the investigational antibiotics currently in clinical trials for the treatment of meningitis, meropenem, a carbapenem-class antibiotic, has demonstrated increased activity against penicillin-resistant pneumococci compared with that of other beta-lactam antibiotics, while having a safety profile similar to that of the cephalosporins.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Child; Child, Preschool; Chloramphenicol; Clindamycin; Female; Fluoroquinolones; Humans; Infant; Infant, Newborn; Lactams; Male; Meningitis, Bacterial; Naphthyridines; Penicillin Resistance; Rifampin; Streptococcal Infections; Streptococcus pneumoniae; Vancomycin; Virginiamycin

Topics: Algorithms; Animals; Anti-Bacterial Agents; Child; Child, Preschool; Deafness; Dexamethasone; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Research; Rifampin

Cefotaxime and ceftriaxone are currently the agents of first choice for empiric treatment of bacterial meningitis in children. Further studies are necessary to determine the optimal antibiotic therapy for meningitis caused by Streptococcus pneumoniae isolates relatively or fully resistant to penicillin. The Haemophilus influenzae type b capsular polysaccharide-protein conjugate vaccines undoubtedly will alter the relative importance of the three common meningeal pathogens in pediatrics and make additional studies of the adjunctive use of dexamethasone in the treatment of bacterial meningitis even more critical.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Bacterial Capsules; Bacterial Vaccines; Dexamethasone; Haemophilus influenzae; Haemophilus Vaccines; Humans; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Pneumococcal Vaccines; Polysaccharides, Bacterial; Rifampin; Streptococcus pneumoniae

Topics: Bacterial Vaccines; Biomarkers; C-Reactive Protein; Child; Counterimmunoelectrophoresis; Enzyme-Linked Immunosorbent Assay; Humans; Latex Fixation Tests; Meningitis, Bacterial; Rifampin

Treatment of acute bacterial meningitis in children with bactericidal antibiotics causes cell wall lysis and a surge in inflammatory cascade, which in turn contributes to neuronal damage and morbidity. Pretreatment with a nonbacteriolytic antibiotic, such as rifampin, has been shown to attenuate the inflammatory response in experimental models of bacterial meningitis. In a pilot study, in children with bacterial meningitis, we have studied markers of inflammatory response and neuronal damage in 2 groups of children with bacterial meningitis; one group received rifampin pretreatment with ceftriaxone and the other group received ceftriaxone alone.. Forty children with bacterial meningitis, who were 3 months to 12 years of age, were randomly assigned to receive either a single dose rifampin (20 mg/kg) 30 minutes before ceftriaxone or ceftriaxone alone was given. The primary outcome variables were cerebrospinal fluid (CSF) concentrations of tumor necrosis factor alpha (TNFα), S100B and neuron-specific enolase on day 1 and day 5, and secondary outcome variables were the values of TNFα and interleukin 6 in serum on day 1 and day 5; hearing and neurologic sequelae at 3 months after recovery from the illness.. Children in rifampin pretreatment group had significantly lower CSF TNFα concentrations [median (interquartile range [IQR]): 15.5 (7.2-22.0) vs. 53.0 (9.0-87.5) pg/mL, P = 0.019] and S100B [median (IQR): 145.0 (54.7-450.0) vs. 447.5 (221.0-804.6) pg/mL, P = 0.033] on day 1 and S100B [median (IQR): 109.7 (64.0-287.0) vs. 322 (106.7-578.0) pg/mL, P = 0.048] and neuron-specific enolase [median (IQR): 8.6 (5-14.75) vs. 18.2 (7.0-28.75) ng/mL, P = 0.035] on day 5 when compared with ceftriaxone alone group. The rifampin-treated group also had reduced morbidity and neurologic sequelae; however, these were not statistically significant.. Pretreatment with single dose rifampin 30 minutes before ceftriaxone administration reduced the CSF concentrations of markers of inflammation and neuronal damage in children with bacterial meningitis.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Cranial Nerve Diseases; Humans; Infant; Inflammation; Interleukin-6; Meningitis, Bacterial; Phosphopyruvate Hydratase; Pilot Projects; Rifampin; S100 Calcium Binding Protein beta Subunit; Treatment Outcome; Tumor Necrosis Factor-alpha

Coagulase-negative staphylococci can cause hospital-acquired infections, especially in immunocompromised hosts. Bacterial meningitis is a potentially fatal infection of the central nervous system, causing high mortality and morbidity. In general, the causative agents of meningitis, coagulase-negative staphylococci, are associated with direct implantation of a foreign body and the presence of a cerebrospinal fluid (CSF) shunt. Here, we describe a case of nosocomial meningitis caused by Staphylococcus haemolyticus in a child with neutropenia who had no intracranial foreign devices.. A 15-year-old boy with relapsed acute myeloid leukemia undergoing chemotherapy through a central venous catheter developed fever on Day 13 post-initiation of chemotherapy. There was no history of implantation of neurosurgical devices. Two blood cultures obtained on Day 14 were positive for Staphylococcus haemolyticus. Clinical improvement was noted, and treatment with vancomycin and removal of the central venous catheter resulted in negative repeat blood cultures on Day 18. However, the patient developed a tendency for somnolence and improper speech, along with persistent fever on Day 26. A lumber puncture was performed on Day 27, resulting in positive culture of Staphylococcus haemolyticus. He was diagnosed with meningitis and the dosage of vancomycin was increased. A repeat CSF culture was positive for Staphylococcus haemolyticus on Day 40, so oral rifampicin was added. CSF findings on Day 46 revealed a low concentration of vancomycin, and treatment was switched from vancomycin plus rifampicin to linezolid. After Day 46, four subsequent cerebrospinal fluid tests of the CSF showed no growth of Staphylococcus haemolyticus. The patient's symptoms were improved on Day 52. Brain and spinal magnetic resonance images was taken and it showed no abnormalities. Linezolid was continued until Day 72. The patient was discharged without any complications on Day 72.. To the best of our knowledge, this is the first reported case of Staphylococcus haemolyticus meningitis in a patient without a neurosurgical device. Typical symptoms or signs may be absent in a patient with meningitis who also has neutropenia. Repeated tests of the CSF, and prolonged duration of antibiotics should be considered if atypical pathogens are detected in immunocompromised hosts.

Topics: Adolescent; Anti-Bacterial Agents; Child; Coagulase; Cross Infection; Hospitals; Humans; Linezolid; Male; Meningitis, Bacterial; Neutropenia; Rifampin; Staphylococcal Infections; Staphylococcus; Staphylococcus haemolyticus; Vancomycin

As daptomycin adjunction is currently under clinical evaluation in the multicentre phase II AddaMAP study to improve the prognosis of pneumococcal meningitis, the present work aimed at evaluating the in vitro antimicrobial activity of daptomycin-based combinations against some of the most frequent species responsible for bacterial meningitis.. Clinically relevant strains of Streptococcus pneumoniae, Listeria monocytogenes, Haemophilus influenzae and Neisseria meningitidis were obtained from National Reference Centers. The antimicrobial activity of amoxicillin, cefotaxime and rifampicin, either alone or in association with daptomycin, was explored through the determination of minimum inhibitory concentration (MIC) and fractional inhibitory concentration index (FICI) as well as time-kill assay (TKA) using the broth microdilution method.. All species taken together, the adjunction of daptomycin had no deleterious impact on the antimicrobial activity of amoxicillin, cefotaxime or rifampicin in vitro. Regarding Gram-positive bacteria, FICI and TKA analysis confirmed a global improvement of growth inhibition and bactericidal activity due to the adjunction of daptomycin. The synergistic effect prevailed for L. monocytogenes as demonstrated by FICI mainly <0.5 and a dynamic TKA-based synergy rate >50%. In addition, daptomycin-based associations did not modify the activity of β-lactam antibiotics or rifampicin against Gram-negative bacteria, notably N. meningitidis.. These results bring comforting evidence towards the clinical potential of daptomycin adjunction in the treatment of bacterial meningitis, which supports the ongoing AddaMAP clinical trial.

Topics: Amoxicillin; Anti-Bacterial Agents; Cefotaxime; Daptomycin; Humans; Meningitis, Bacterial; Rifampin

Elizabethkingia meningoseptica (E. meningoseptica ) are Gram-negative bacteria commonly associated with nosocomial infections in neonates. This is a case study of E. meningoseptica, presented as meningitis and sepsis in a term baby. The female infant was born by vaginal delivery at 37 weeks gestational age. The case was peculiar because the baby was neither premature nor immuno-compromised, which are known risk factors for E. meningoseptica infection. The onset began on the second day of the neonate's life. On day 3, peripheral blood culture and cerebrospinal fluid findings isolated a gram-negative bacteria identified as E. meningoseptica. The first-line antibiotics therapy was changed to ciprofloxacin, vancomycin, and rifampicin, based on the laboratory determination of antimicrobial sensitivity. The patient's clinical condition improved, although post hemorrhagic ventricular dilatation was revealed by imaging studies. Clinicians should possess proper awareness of the antibiotic sensitivity of E. meningoseptica, as it is important in preventing high rates of morbidity and mortality.

Topics: Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Flavobacteriaceae; Flavobacteriaceae Infections; Humans; Infant, Newborn; Meningitis, Bacterial; Rifampin; Saudi Arabia; Sepsis; Treatment Outcome; Vancomycin

Spontaneous methicillin-resistant Staphylococcus aureus (MRSA) meningitis is extremely rare and has a high mortality rate. We report a case of MRSA meningitis in an otherwise healthy young adult female with no recent trauma or neurosurgical interventions. Despite antibiotics she suffered a vasculitis-induced cerebral vascular ischemic event.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Aspirin; Cerebellum; Female; Humans; Meningitis, Bacterial; Methicillin-Resistant Staphylococcus aureus; Prednisone; Rifampin; Risk Factors; Severity of Illness Index; Staphylococcal Infections; Vancomycin; Young Adult

Bacterial meningitis among critically ill adult patients remains associated with both high mortality and frequent, persistent disability. Vancomycin was added to treatment with a third-generation cephalosporin as recommended by French national guidelines. Because animal model studies had suggested interest in the use of rifampin for treatment of bacterial meningitis, and after the introduction of early corticosteroid therapy (in 2002), there was a trend toward increasing rifampin use for intensive care unit (ICU) patients. The aim of this article is to report on this practice.. Five ICUs participated in the study. Baseline characteristics and treatment data were retrospectively collected from charts of patients admitted with a diagnosis of acute bacterial meningitis during a 5-year period (2004-2008). The ICU mortality was the main outcome measure; Glasgow Outcome Scale and 3-month mortality were also assessed.. One hundred fifty-seven patients were included. Streptococcus pneumoniae and Neisseria meningitidis were the most prevalent causative microorganisms. The ICU mortality rate was 15%. High doses of a cephalosporin were the most prevalent initial antimicrobial treatment. The delay between admission and administration of the first antibiotic dose was correlated with ICU mortality. Rifampin was used with a cephalosporin for 32 patients (ranging from 8% of the cohort for 2004 to 30% in 2008). Administration of rifampin within the first 24 h of hospitalization could be associated with a lower ICU survival. Statistical association between such an early rifampin treatment and ICU mortality reached significance only for patients with pneumococcal meningitis (p=0.031) in univariate analysis, but not in the logistic model.. We report on the role of rifampin use for patients with community-acquired meningitis, and the results of this study suggest that this practice may be associated with lower mortality in the ICU. Nevertheless, the only independent predictors of ICU mortality were organ failure and pneumococcal infection. Further studies are required to confirm these results and to explain how rifampin use would reduce mortality.

Topics: Anti-Bacterial Agents; Community-Acquired Infections; Female; France; Glasgow Outcome Scale; Hospital Mortality; Humans; Intensive Care Units; Male; Meningitis, Bacterial; Meningitis, Meningococcal; Meningitis, Pneumococcal; Middle Aged; Neisseria meningitidis; Retrospective Studies; Rifampin; Treatment Outcome

To evaluate in vitro and in vivo efficacies of linezolid, vancomycin, and the combination of linezolid and rifampicin against two Staphylococcus aureus strains with reduced susceptibility to beta-lactams and one of them also to glycopeptides.. In vitro killing curves and a rabbit model: Meningitis was induced by intracisternal inoculation of 10(8) CFU/ml of each strain. Five hours later (0 h), rabbits were randomly assigned to control or to therapeutic groups. CSF bacterial counts, lactate and protein concentrations, and pharmacokinetic parameters were determined.. In vivo: linezolid and its combination with rifampicin reduced bacterial concentrations at 24 h, median cfu/mL 4.85 vs 3.87 (p < 0.05) for linezolid and 5.02 vs 4.21 (p < 0.05) for linezolid + rifampicin, against the glycopeptide intermediate S. aureus (GISA) strain and improved inflammatory parameters.. Despite the need for more experimental data, our results suggest that linezolid and its combinations could be considered as a potential alternative in difficult-to-treat CNS infections and especially in those due to GISA strains and deserve more studies.

Topics: Acetamides; Animals; Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactams; Disease Models, Animal; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Glycopeptides; Linezolid; Meningitis, Bacterial; Microbial Sensitivity Tests; Oxazolidinones; Rabbits; Random Allocation; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Septic cavernous sinus thrombosis is a rare clinical condition. Although Staphylococcus aureus is the most common pathogen causing septic cavernous sinus thrombosis [CST], it is an uncommon cause of meningitis. We report the first case of CST with meningitis in Hyderabad, Andhra Pradesh, caused by community acquired epidemic strain of Methicillin resistant staphylococcus aureus [MRSA], in a previously healthy individual with no risk factors. The patient recovered completely following treatment with Vancomycin. We consecutively reviewed all cases of community acquired staphylococcus aureus [CA-MRSA] with central nervous system involvement available in literature.

Topics: Adolescent; Basal Ganglia Cerebrovascular Disease; Brain; Cavernous Sinus Thrombosis; Cerebral Infarction; Community-Acquired Infections; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Meningitis, Bacterial; Methicillin-Resistant Staphylococcus aureus; Rifampin; Staphylococcal Infections

We report a case of postsurgical meningitis caused by multiresistant Acinetobacter baumannii successfully treated with high doses of ampicillin/sulbactam combined with rifampicin and fosfomycin.

Topics: Accidents, Traffic; Acinetobacter baumannii; Acinetobacter Infections; Adult; Ampicillin; Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Fosfomycin; Humans; Male; Meningitis, Bacterial; Postoperative Complications; Rifampin; Sulbactam

A 64-year-old woman presented with fever and headache. Lumbar puncture revealed cerebrospinal fluid (CSF) that contained 67,386 /mm(3) of WBC; CSF culture revealed Actinomyces species. She was diagnosed with purulent meningitis caused by actinomyces, and treated with intravenous ampicillin 12 g/day. The administration of ampicillin was effective, but not sufficient to control the inflammation in CSF. CSF inflammation persisted and a gradual increase in granulation tissue was found in the subdural space on lumbar MRI. After administration of rifampicin 450 mg/day, the CSF was normalized and the enhancement of granulation tissue decreased. The patient completely recovered 5 months after the therapy was initiated. We suggest that rifampicin may be an option for the treatment of meningitis caused by actinomyces.

Topics: Actinomyces; Actinomycosis; Ampicillin; Anti-Bacterial Agents; Female; Humans; Magnetic Resonance Imaging; Meningitis, Bacterial; Middle Aged; Rifampin

Methicillin-resistant Staphylococcus aureus (MRSA) meningitis is associated with a high mortality rate. Treatment is challenging in patients with allergy to vancomycin. Herein, we describe a case of MRSA bacteremia secondary to medical device infection with MRSA that was complicated by MRSA meningitis. This case provides evidence for a possible role of combination therapy of daptomycin, linezolid, and rifampin in cases of MRSA meningitis and bacteremia.

Topics: Acetamides; Anti-Bacterial Agents; Bacteremia; Daptomycin; Drug Therapy, Combination; Humans; Linezolid; Male; Meningitis, Bacterial; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Oxazolidinones; Rifampin; Staphylococcal Infections; Treatment Outcome

Elizabethkingia meningoseptica is a rare but well-recognised cause of neonatal meningitis. Reported outbreaks have involved very few cases. We describe the management and outcome of a relatively large outbreak of E.meningoseptica neonatal meningitis. From August 2002 to December 2003, eight cases of meningitis caused by E. meningoseptica occurred among babies admitted to the neonatal ward of Jawarhlal Nehru hospital, Mauritius. In all cases, the organism was isolated from the cerebrospinal fluid. Infection control measures were re-emphasized after each case and environmental swabs were cultured on several occasions. . The affected babies were aged 6 to 20 days (mean age of 10 days). Seven of the babies weighed < 2,500 g. All CSF isolates had the same antibiotic susceptibility pattern. Apart from one baby who died shortly after admission, all cases responded to treatment with intravenous piperacillin and oral rifampicin for three weeks. Hydrocephalus developed in two babies and was subsequently fatal in one case. At follow-up of the other cases, one baby had severe neurological sequelae but a full recovery was observed in the other four cases. The source of the outbreak could not be established conclusively. . The outcome was better than what has been reported in the medical literature. Prompt identification of the causative organism and initiation of appropriate antimicrobial therapy is essential. The combination of piperacillin and rifampicin should be considered an option for the treatment of E. meningoseptica neonatal meningitis if supported by properly performed antibiotic susceptibility test results. 

Topics: Anti-Bacterial Agents; Cerebrospinal Fluid; Disease Outbreaks; Environmental Microbiology; Female; Flavobacteriaceae; Flavobacteriaceae Infections; Humans; Hydrocephalus; Infant, Newborn; Male; Mauritius; Meningitis, Bacterial; Microbial Sensitivity Tests; Piperacillin; Rifampin; Treatment Outcome

There are currently no defined optimal therapies available for multidrug-resistant (MDR) Acinetobacter baumannii infections. We evaluated the efficacy of rifampin, imipenem, sulbactam, colistin, and their combinations against MDR A. baumannii in experimental pneumonia and meningitis models. The bactericidal in vitro activities of rifampin, imipenem, sulbactam, colistin, and their combinations were tested using time-kill curves. Murine pneumonia and rabbit meningitis models were evaluated using the A. baummnnii strain Ab1327 (with MICs for rifampin, imipenem, sulbactam, and colistin of 4, 32, 32, and 0.5 mg/liter, respectively). Mice were treated with the four antimicrobials and their combinations. For the meningitis model, the efficacies of colistin, rifampin and its combinations with imipenem, sulbactam, or colistin, and of imipenem plus sulbactam were assayed. In the pneumonia model, compared to the control group, (i) rifampin alone, (ii) rifampin along with imipenem, sulbactam, or colistin, (iii) colistin, or (iv) imipenem plus sulbactam significantly reduced lung bacterial concentrations (10.6 +/- 0.27 [controls] versus 3.05 +/- 1.91, 2.07 +/- 1.82, 2.41 +/- 1.37, 3.4 +/- 3.07, 6.82 +/- 3.4, and 4.22 +/- 2.72 log(10) CFU/g, respectively [means +/- standard deviations]), increased sterile blood cultures (0% versus 78.6%, 100%, 93.3%, 93.8%, 73.3%, and 50%), and improved survival (0% versus 71.4%, 60%, 46.7%, 43.8%, 40%, and 85.7%). In the meningitis model rifampin alone or rifampin plus colistin reduced cerebrospinal fluid bacterial counts (-2.6 and -4.4 log(10) CFU/ml). Rifampin in monotherapy or with imipenem, sulbactam, or colistin showed efficacy against MDR A. baumannii in experimental models of pneumonia and meningitis. Imipenem or sulbactam may be appropriate for combined treatment when using rifampin.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Animals; Colistin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Humans; Imipenem; Meningitis, Bacterial; Mice; Mice, Inbred C57BL; Microbial Sensitivity Tests; Pneumonia, Bacterial; Rabbits; Rifampin; Sulbactam; Treatment Outcome

To report a relatively rare presentation of methicillin-resistant Staphylococcus aureus (MRSA) meningitis in a previously healthy boy in Kuwait.. A 14-year-old boy presented with a 2 weeks' history of headache and fever with increasing severity. He developed photophobia and double vision 2 days prior to his hospital visit and received ceftriaxone for 6 days prior to admission to the hospital. There was no history of head trauma or neurosurgical operation. Lumbar puncture revealed a slightly turbid cerebrospinal fluid with pleocytosis and greatly reduced glucose, elevated protein level and on culture grew MRSA. Staphylococcal chromosome cassette mec (SCCmec) typing revealed that it belonged to SCCmec type III and sequence type 238 (ST238-SCCmec-III). Polymerase chain reaction screening for the presence of Panton-Valentine leukocidin (PVL) genes yielded a negative result; all these findings were consistent with hospital-acquired MRSA. He was treated with intravenous linezolid and rifampicin for 2 weeks, made good response and was discharged home fully recovered and well.. Hospital MRSA should be considered in the differential diagnosis of the causative agents of community-onset meningitis in healthy patients even without predisposing factor.

Topics: Acetamides; Adolescent; Anti-Bacterial Agents; Community-Acquired Infections; Humans; Linezolid; Male; Meningitis, Bacterial; Methicillin-Resistant Staphylococcus aureus; Oxazolidinones; Rifampin

Meningitis is a rare clinical manifestation of invasive group A streptococcal (iGAS) disease. Clinical, microbiological and molecular characteristics of 6 consecutive cases of GAS meningitis treated in Haukeland University Hospital in the period 2004-2009 are described. All 6 patients had a primary upper respiratory tract infection, with subsequent mastoiditis in 5, subdural effusions in 2, and cerebral abscess in 1. Five patients needed surgical treatment (myringotomy, craniotomy or mastoidectomy). All patients were treated with a beta-lactam antibiotic in combination with rifampicin. The course was complicated in all cases, and 1 patient died. Three of the bacterial isolates were of the sequence type emm1.0 and they shared the same superantigen gene profile (speA, speG, speJ, smeZ). The remaining 3 isolates belonged to sequence types emm 3.1, emm6.4 and emm12.0. Deletions in emm genes were observed. This report describes the severe and complicated course of GAS meningitis and its management, often requiring surgical intervention.

Topics: Adolescent; Aged; Anti-Bacterial Agents; Antigens, Bacterial; Bacterial Outer Membrane Proteins; beta-Lactams; Carrier Proteins; Child; Female; Gene Deletion; Humans; Male; Mastoiditis; Meningitis, Bacterial; Microbial Sensitivity Tests; Middle Aged; Norway; Rifampin; Streptococcal Infections; Streptococcus pyogenes; Superantigens

Brucellosis is a rare disease in which neurological complications, and more particularly, intracranial aneurysmal hemorrhages were rarely reported.. A brucellar meningitis was diagnosed in a 29-year-old man, who had been suffering from an unusual headache for about two months. Three days after beginning treatment, the patient developed an intracranial right frontal hemorrhage that led to the discovery of a ruptured anterior communicating artery aneurysm. The aneurysm was clipped surgically and doxycycline and rifampin were given for three months. The outcome was excellent.. Clinical manifestations of brucellosis are variable. Neurovascular complications are rare and probably linked to delay in diagnosis of CNS invasion or inadequate initial treatment. Appropriate and prompt medical, and if necessary, surgical management can lead to excellent outcome.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Cerebral Ventriculography; Doxycycline; Humans; Male; Meningitis, Bacterial; Rifampin; Subarachnoid Hemorrhage; Tomography, X-Ray Computed

Brucellosis is prevalent in North and East Africa, the Middle East, South and Central Asia, South and Central America and the Mediterranean countries of Europe. In 5% of cases it may lead to central nervous system manifestation presenting most often as a meningitis or meningoencephalitis. Here we report and discuss a case of neurobrucellosis with meningitis with cranial nerves neuritis. A 56-year-old German male was admitted with bilateral abducens nerve palsy, amblyacousia and intractable headaches. An enzyme-linked immunosorbent assay (ELISA) revealed antibodies against Brucella in serum and cerebrospinal fluid (CSF). Additionally, our patient suffered from an infarction of the left thalamus. In conclusion, in cases of unresponsive meningitis or meningoencephalitis and history of travel in endemic regions, neurobrucellosis should be considered. If initial microbiological tests fail, complementary investigations such as ELISA are indicated to detect Brucella species in serum and/or CSF.

Topics: Abducens Nerve Diseases; Anti-Bacterial Agents; Anti-Inflammatory Agents; Brain Infarction; Brucella; Brucellosis; Cranial Nerve Diseases; Doxycycline; Headache; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Methylprednisolone; Middle Aged; Rifampin; Thalamic Diseases; Treatment Outcome

Opportunistic infections contribute to morbidity and mortality of patients undergoing hematopoietic stem cell transplantation and treatment for malignancies. Rothia mucilaginosa, a gram-positive bacterium, is responsible for rare, but often fatal meningitis in severely immunocompromised patients. We describe two cases of meningitis from discrete strains of R. mucilaginosa on our pediatric bone marrow transplant unit, summarize the published cases of R. mucilaginosa meningitis in oncology and stem cell transplant patients, and provide updated recommendations regarding the use of antibiotic therapy in this patient population.

Topics: Actinomycetales Infections; Adolescent; Anti-Bacterial Agents; Ceftazidime; Cerebrospinal Fluid Shunts; Child; Cord Blood Stem Cell Transplantation; Drug Therapy, Combination; Fatal Outcome; Female; Humans; Immunocompromised Host; Leukemia, Megakaryoblastic, Acute; Male; Meningitis, Bacterial; Meropenem; Micrococcaceae; Opportunistic Infections; Postoperative Complications; Rifampin; Sepsis; Thienamycins; Vancomycin

A 35-year-old man presented with a meningeal syndrome and acute onset of visual blurring. Clinical investigations revealed bacterial meningitis with bilateral papillitis and ophthalmoparesis. Serum and cerebrospinal fluid serology confirmed the diagnosis of chronic active neurobrucellosis. Following therapy there was no improvement and he developed optic atrophy. Extensive literature review revealed, one case of bilateral irreversible papillitis resulting from neurobrucellosis. However no cases of neurobrucellosis have been reported with meningitis, irreversible papillitis and ophthalmoparesis. This case demonstrates that in endemic areas, acute meningitis is a potential manifestation of neurobrucellosis and that bilateral irreversible papillitis with ophthalmoparesis can be a potential serious complication.

Topics: Acute Disease; Adrenal Cortex Hormones; Adult; Brucella abortus; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Follow-Up Studies; Humans; Male; Meningitis, Bacterial; Ophthalmoplegia; Optic Atrophy; Papilledema; Rifampin; Streptomycin

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Ceftriaxone; Dexamethasone; Floxacillin; Gentamicins; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Methylprednisolone; Rifampin; Staphylococcal Infections; Vasculitis

Topics: Acetamides; Anti-Bacterial Agents; Drug Therapy, Combination; Female; Humans; Linezolid; Meningitis, Bacterial; Methicillin Resistance; Middle Aged; Oxazolidinones; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Treatment Outcome; Vancomycin

Topics: Acinetobacter; Acinetobacter Infections; Adult; Anti-Bacterial Agents; Cerebrospinal Fluid; Drug Therapy, Combination; Female; Humans; Meningitis, Bacterial; Meropenem; Microbial Sensitivity Tests; Rifampin; Subarachnoid Hemorrhage; Thienamycins; Ventriculostomy

Cerebrospinal fluid (CSF) concentration-time curves of rifampicin and fusidic acid were studied in a patient with post-operative meningitis caused by Staphylococcus epidermidis. The patient was treated with this combination of antimicrobial agents because of a severe hypersensitivity reaction to vancomycin. Peak CSF concentrations of rifampicin exceeded the MIC by > 60-fold, while those of fusidic acid just reached the MIC. CSF concentrations of fusidic acid were relatively stable within the range reported for patients with uninflamed meninges, but serum levels were surprisingly low. An increase in the metabolism of fusidic acid induced by rifampicin cannot be excluded.

Topics: Anti-Bacterial Agents; Cerebrospinal Fluid; Fusidic Acid; Humans; Inflammation; Male; Meningitis, Bacterial; Middle Aged; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis

An 11-year-old boy presented with chronic meningitis followed by acute flaccid paralysis. The aetiology remained uncertain until the brucellar serology test became positive and there was a good response to specific antimicrobial therapy. Nerve conduction studies confirmed a proximal radiculopathy. Awareness of the condition and performance of the appropriate tests will differentiate neurobrucellosis from other chronic central nervous system infections.

Topics: Anti-Bacterial Agents; Brucellosis; Central Nervous System Bacterial Infections; Child; Chronic Disease; Doxycycline; Humans; Male; Meningitis, Bacterial; Neural Conduction; Paralysis; Radiculopathy; Rifampin

Topics: Antibiotics, Antitubercular; Coagulase; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Meningitis, Bacterial; Rifampin; Staphylococcal Infections; Staphylococcus; Treatment Outcome; Vancomycin

Topics: Anti-Bacterial Agents; Cefotaxime; Child, Preschool; Gram-Positive Bacterial Infections; Humans; Male; Meningitis, Bacterial; Micrococcaceae; Neutropenia; Rifampin; Vancomycin

Topics: Biomarkers; C-Reactive Protein; Dexamethasone; Drug Therapy, Combination; Humans; Meningitis, Bacterial; Rifampin

This statement provides guidelines for therapy of children with serious infections possibly caused by Streptococcus pneumoniae. Resistance of invasive pneumococcal strains to penicillin, cefotaxime, and ceftriaxone has increased over the past few years. Reports of failures of cefotaxime or ceftriaxone in the treatment of children with meningitis caused by resistant S pneumoniae necessitates a revision of Academy recommendations. For nonmeningeal infections, modifications of the initial therapy need to be considered only for patients who are critically ill and those who have a severe underlying or potentially immunocompromising condition or patients from whom a highly resistant strain is isolated. Because vancomycin is the only antibiotic to which all S pneumoniae strains are susceptible, its use should be restricted to minimize the emergence of vancomycin-resistant organisms. Patients with probable aseptic (viral) meningitis should not be treated with vancomycin. These recommendations are subject to change as new information becomes available.

Topics: Anti-Bacterial Agents; Child; Diagnosis, Differential; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; Meningitis, Bacterial; Meningitis, Viral; Microbial Sensitivity Tests; Pneumococcal Infections; Rifampin; Vancomycin

Topics: Ampicillin; Cerebrospinal Fluid; Drug Therapy, Combination; Humans; Male; Meningitis, Bacterial; Middle Aged; Rifampin; Streptococcus pneumoniae

Topics: Antineoplastic Combined Chemotherapy Protocols; Antitubercular Agents; Child, Preschool; Drug Contamination; Ethionamide; Female; Humans; Iatrogenic Disease; Immunocompromised Host; Isoniazid; Male; Meningitis, Bacterial; Mycobacterium bovis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrazinamide; Rifampin; Streptomycin; Tuberculosis, Meningeal

Topics: Community-Acquired Infections; Drug Therapy, Combination; Flavobacterium; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Male; Meningitis, Bacterial; Rifampin; Vancomycin

There is little evidence supporting the efficacy of prophylactic antibiotics in preventing secondary cases of bacterial meningitis, and recent guidance extended the use of prophylactic antibiotics amongst children who attend pre-school groups.. We examined the volume of rifampicin prescribed, and that recommended to contacts of cases of meningococcal and Hib meningitis in Somerset over a three-year period using case note records of the Consultant for Communicable Disease Control (CCDC) and PACT data.. There was evidence of excessive prescribing over and above that recommended by the CCDC.. Excessive prescribing increases the chance of serious drug side effects and the development of antibiotic resistance. It is suggested that both meningitis contacts and information about early symptoms of meningitis, as well as an explanation of the rationale behind the prescribing of antibiotic prophylaxis to contacts. This may reduce the likelihood of unnecessary prescribing and subsequent complications.

Topics: Adult; Antibiotic Prophylaxis; Child; Child Day Care Centers; Child, Preschool; Contact Tracing; Cross Infection; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Utilization; England; Family Practice; Female; Health Services Misuse; Humans; Infant; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Rifampin; Risk; Treatment Outcome

Infection of cerebrospinal fluid (CSF) shunts is one of the major complications associated with their use and is usually managed by shunt removal, temporary insertion of an external drainage and implantation of a new shunt system. We have evaluated the efficacy of a rifampin-loaded silicone ventricular catheter to prevent bacterial colonization and infection in vitro and in an animal model. On the basis of an incorporation process a rifampin-loaded catheter was developed which is capable of releasing rifampin in bacteriocidal concentrations for 60 days and more. In a stationary bacterial adherence assay using S. epidermidis as test strain, the colonization resistance of the device was demonstrated. To assess the capability of the catheter to prevent CSF shunt infections, a rabbit model was developed which allowed the establishment of a reliable and reproducible CSF infection by implantation of silicone catheters into the ventricle and inoculating S. epidermidis (minimal dose 10(6) cfu) or S. aureus (minimal dose 10(3) cfu). Rifampin-loaded catheters (12 animals inoculated with S. epidermidis, 8 animals inoculated with S. aureus) were compared with non-loaded (14 animals inoculated with S. epidermidis, 19 animals inoculated with S. aureus) control catheters, and infection was documented by clinical, microbiological and histological methods. In contrast to the control group, none of the animals with rifampin-loaded catheters showed clinical signs of infection. Furthermore, in none of the materials obtained after sacrifice of the animals (catheter, brain tissue, CSF, blood) could the infecting bacteria be cultured, whereas in materials from animals with the unloaded catheter the infecting strains could always be cultured from the catheter and from surrounding brain tissue. The histological examination of catheter-adjacent tissue supported these findings. We conclude that a rifampin-loaded silicone ventricular catheter is capable of completely preventing bacterial colonization and infection by staphylococci as the main causative organisms in CSF shunt infections and should be further evaluated in clinical trials.

Topics: Animals; Catheters, Indwelling; Cerebrospinal Fluid Shunts; Colony Count, Microbial; Dose-Response Relationship, Drug; Equipment Design; Meningitis, Bacterial; Microbial Sensitivity Tests; Rabbits; Rifampin; Silicones; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis

A modified rabbit meningitis model is described for determining the PAE in vivo, which utilised a self-standing device for repeatedly sampling pure CSF. The model allowed the PAEs of ciprofloxacin and rifampicin on Escherichia coli ATCC 25922 to be determined following PAE induction in vitro, or in vivo in CSF after intrathecal injection or during the last 1.5 h of a 7 h iv continuous infusion. The estimated volumes of distribution of ciprofloxacin and rifampicin in CSF were 0.68 +/- 0.24 mL and 0.74 +/- 0.04 mL, respectively, and the terminal elimination half lives were 1.8 +/- 0.5 h and 2.2 +/- 0.3 h, respectively. PAEs of approximately 2 h were obtained in vivo and in vitro after exposing E. coli to 3 x MIC of ciprofloxacin in vitro and to 1 x MIC of drug in vivo. When the organism was exposed to rapidly declining concentrations in vivo, only a minimal PAE was observed for both antibiotics. Moreover, a PAE of 3.1 +/- 1.3 h of rifampicin was obtained in vivo, being smaller than the 4.8 h PAE observed in vitro, which might be explained by the binding of 45 +/- 6.5% rifampicin to proteins in the CSF.

Topics: Animals; Anti-Infective Agents; Antibiotics, Antitubercular; Ciprofloxacin; Disease Models, Animal; Dose-Response Relationship, Drug; Escherichia coli; Female; Infusions, Intravenous; Injections, Spinal; Meningitis, Bacterial; Microbial Sensitivity Tests; Rabbits; Rifampin

Important aspects of the management of meningitis in children include notification to local officers for control of communicable diseases; chemoprophylaxis for index cases and close contacts in cases of meningococcal or Haemophilus influenzae meningitis; and a formal hearing assessment for all survivors. A retrospective audit of these aspects of management was carried out for children admitted with meningitis in 12 months from 1 September 1990 to 31 August 1991 at the Royal Belfast Hospital for Sick Children. Only 20 of 36(56%) cases were notified by medical staff. Chemoprophylaxis was arranged for all close family contacts but to only five of the 23(22%) index cases for whom it was indicated. Appointments for audiological testing were arranged for only 19 of the 32(59%) survivors. Subsequently all doctors, including each intake of junior doctors, were given written information on the importance of notification and locally agreed guidelines for chemoprophylaxis and hearing assessments for survivors before discharge. Guidelines were also displayed prominently in each ward. A repeat audit from January 1992 to December 1992 showed significant improvement in these aspects of care. Twenty eight of 32 cases (88%) were notified, chemoprophylaxis was given to 20 of 22(91%) index cases for whom it was indicated, and 25 of 29(86%) survivors had hearing assessments arranged before discharge. Correct management of some aspects of care cannot be assumed, even if statutory (notification), nationally agreed (chemoprophylaxis), or generally agreed good practice (hearing assessments). These aspects of care improved after the first audit but the authors conclude that the notification rate remains below 100% and a repeat audit is necessary.

Topics: Adolescent; Child; Child, Preschool; Disease Notification; Hearing Loss, Sensorineural; Hearing Tests; Humans; Infant; Medical Audit; Meningitis, Bacterial; Meningitis, Viral; Northern Ireland; Practice Guidelines as Topic; Retrospective Studies; Rifampin

Ventricular obstruction and hydrocephalus are recognized complications of neurosurgical procedures and meningitis that has been previously treated. The confinement of bacterial meningitis solely to a lateral ventricle in an otherwise healthy individual, however, is rare. I describe a case in which a ventricular abscess occurred as the presenting manifestation of staphylococcal meningitis in a man who had no history of head trauma or neurosurgery.

Topics: Adult; Brain Abscess; Cerebral Ventricles; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Nafcillin; Rifampin; Staphylococcal Infections; Tomography, X-Ray Computed; Vancomycin

The aim was to audit, against agreed standards, the control of bacterial meningitis, in particular completeness of notification and appropriateness of distribution of chemoprophylaxis to contacts; and to implement appropriate changes and monitor their impact.. The first phase involved determination, for the years 1983 and 1984, of completeness of notification by comparison with a comprehensive case register. Information about chemoprophylaxis was obtained from case notes, questionnaires to general practitioners and other records. The second phase involved introducing a programme of clinician education in the hospital with the poorest observed notification performance and re-examining performance during 1988. Districtwide education regarding chemoprophylaxis was undertaken and the situation re-examined in 1988.. The study took place in Mid Glamorgan Health Authority (population 536,000), with four acute hospitals.. Consisted of all the residents of Mid Glamorgan Health Authority.. During the first phase of the audit only 28 out of 79 cases of bacterial meningitis were notified (35%). Performance in one hospital was significantly worse than in the other three. Chemoprophylaxis was distributed to 20 out of 26 (77%) cases of meningococcal meningitis but inappropriate drugs were used in four cases and prophylaxis was distributed more widely than is recommended in 10 cases. In the phase 2 re-examination, a significant improvement in notification was observed in the hospital where special measures were taken, with no change in a "control" hospital. Chemoprophylaxis improved throughout the District, although rifampicin continued to be distributed too widely.. As a result of this audit, measurable improvements in both infectious disease notification and chemoprophylaxis practice were obtained by the education of clinicians. The study provides a good example of a completed audit cycle in public health medicine.

Topics: Communicable Disease Control; Humans; Medical Audit; Meningitis, Bacterial; Program Evaluation; Rifampin; Wales