Bacterial meningitis in infants and children.

Bacterial meningitis of infants and children exact a major toll worldwide. Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis continue to be the major causes, and efforts to reduce the incidence of this disease have had limited success. Major advances in rapid diagnosis, such as antigen detection, have occurred over the past several decades; however, Gram stain, cytologic examination and culture of the CSF remain the most reliable means of making an etiologic diagnosis. Despite shifts in bacterial susceptibilities to commonly used antibacterial agents, penicillin, ampicillin and chloramphenicol remain effective therapy for the vast majority of cases, although newer cephalosporin derivatives may be required to avoid the toxicities of chloramphenicol and to effectively treat selected bacteria that have developed resistance to these more classical antibiotics. The prognosis for bacterial meningitis in infants and children remains guarded because of late diagnosis and the severity of the disease. Major reductions in the incidence of the disease will depend on definition of high-risk populations and application of appropriate preventions.