Advances in diagnosis and treatment of childhood meningitis.

The seriousness of bacterial meningitis in pediatrics mandates more rapid and accurate diagnostic tests. Of the available tests to detect bacterial antigens, latex particle agglutination appears to be the best because it is simple and highly sensitive. For differentiation between bacterial and aseptic meningitis, serum C-reactive protein levels in excess of 50 mg/liter and cerebrospinal fluid lactate levels higher than 2.2 mmol/ml indicate a bacterial etiology. Available data confirm that one of the newer "third generation" cephalosporins can be used effectively and safely as a single drug for therapy of meningitis caused by the usual spectrum of bacteria, if the achievable cerebrospinal fluid drug levels exceed the minimal inhibitory concentration of the infecting bacteria by at least 10-fold. Use of these agents will obviate the potential toxicity of current antibiotics and may result in considerable cost savings.