Short-course therapy for adult meningococcal sepsis and/or meningitis: 23-year experience
Abstract number: P716
Cabellos C., Verdaguer R., Cisnal M., Pallares R., Ariza X., Gudiol F., Viladrich P.F.
Objective: Short course therapy for meningococcal disease have been previously shown as effective as longer therapies. In order to reinforce our results in adults we present our accumulated experience in 138 patients (pts) treated with a short course therapy for systemic meningococcal disease.
Patients and Methods: All pts admitted to our hospital with systemic meningococcal disease (positive blood or CSF culture or meningitis with petechial purpura) from January 1984 have been scheduled to a short 4 days antibiotic therapy and have been compared with the historical 7 days treated pts. Data were prospectively recorded in a 128 variables protocol.
Results: 138 adult pts (37 M/101 F) mean age 45.5±20 (1887) were evaluated. Mean duration of therapy was 4.9±2 days, median 4 days. 17 pts presented shock on admission, 38 pts were treated with penicillin, 90 with ceftriaxone, 5 with cefotaxime and 4 with other drugs. Mortality was 13/138 (9%) due to early sepsis in 5 pts, neurological complications in 1 and late causes in 7. Mild neurological sequelae were present in 15 pts (12%). No relapses were observed after one month follow-up. When compared with pts treated previously with a 7 days or longer therapy course, 129 pts, (36 M/93 F) mean age 43.8±19 (1880), mean duration of therapy 7.22 days, there were no differences in positive blood cultures, shock on admission (25 pts) mortality 12/129 (9%), due to early sepsis in 9 pts and neurological complications in 3, relapse (no cases) or sequelae 12 (10%) (NS). Antibiotic therapy in this long course therapy group consisted in penicilIin 119 pts, ampicillin 4 pts and chloramfenicol 6 pts.
Among short course therapy pts, in the subgroup of 16 pts presenting as sepsis without meningitis (1M/15 F) mean age 47.38±22 (1882) with shock on admission in 3 pts treated for 4.6±2 days there were a mortality of 1/16 (6%), no relapses and sequelae were present in 1 patient without differences with the previously long-therapy treated pts. In the subgroup of 10 pts presenting as severe sepsis (hypotension or shock + thrombopenia + coagulation disorder with or without meningitis) with mean age 49.6 (2173), shock in 7/10 and disseminated intravascular coagulation in 8/10 mortality was 3/10 (30%) all of them in the first day of therapy.
Conclusion: Short course (4 days) antibiotic therapy in adult meningococcal disease either meningitis or sepsis (including severe sepsis) is a safe therapy without relapses.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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