scholarly journals Fever Interval before Diagnosis, Prior Antibiotic Treatment, and Clinical Outcome for Young Children with Bacterial Meningitis

2001 ◽  
Vol 32 (4) ◽  
pp. 566-572 ◽  
Author(s):  
B. K. Bonsu ◽  
M. B. Harper
Keyword(s):  
Young Children ◽  
Clinical Outcome ◽  
Bacterial Meningitis ◽  
Antibiotic Treatment ◽  
Prior Antibiotic Treatment

scholarly journals The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

2016 ◽  
Vol 20 (51) ◽  
pp. 1-294 ◽  
Author(s):  
Alastair D Hay ◽  
Kate Birnie ◽  
John Busby ◽  
Brendan Delaney ◽  
Harriet Downing ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Cost Effectiveness ◽  
Tract Infection ◽  
Young Children ◽  
Clinical Diagnosis ◽  
Antibiotic Treatment ◽  
Clinical Judgement ◽  
Index Tests

BackgroundIt is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or not dipstick testing should be used to inform antibiotic treatment.ObjectivesTo develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness.DesignMulticentre, prospective diagnostic cohort study.Setting and participantsChildren < 5 years old presenting to primary care with an acute illness and/or new urinary symptoms.MethodsOne hundred and seven clinical characteristics (index tests) were recorded from the child’s past medical history, symptoms, physical examination signs and urine dipstick test. Prior to dipstick results clinician opinion of UTI likelihood (‘clinical diagnosis’) and urine sampling and treatment intentions (‘clinical judgement’) were recorded. All index tests were measured blind to the reference standard, defined as a pure or predominant uropathogen cultured at ≥ 105colony-forming units (CFU)/ml in a single research laboratory. Urine was collected by clean catch (preferred) or nappy pad. Index tests were sequentially evaluated in two groups, stratified by urine collection method: parent-reported symptoms with clinician-reported signs, and urine dipstick results. Diagnostic accuracy was quantified using area under receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) and bootstrap-validated AUROC, and compared with the ‘clinician diagnosis’ AUROC. Decision-analytic models were used to identify optimal urine sampling strategy compared with ‘clinical judgement’.ResultsA total of 7163 children were recruited, of whom 50% were female and 49% were < 2 years old. Culture results were available for 5017 (70%); 2740 children provided clean-catch samples, 94% of whom were ≥ 2 years old, with 2.2% meeting the UTI definition. Among these, ‘clinical diagnosis’ correctly identified 46.6% of positive cultures, with 94.7% specificity and an AUROC of 0.77 (95% CI 0.71 to 0.83). Four symptoms, three signs and three dipstick results were independently associated with UTI with an AUROC (95% CI; bootstrap-validated AUROC) of 0.89 (0.85 to 0.95; validated 0.88) for symptoms and signs, increasing to 0.93 (0.90 to 0.97; validated 0.90) with dipstick results. Nappy pad samples were provided from the other 2277 children, of whom 82% were < 2 years old and 1.3% met the UTI definition. ‘Clinical diagnosis’ correctly identified 13.3% positive cultures, with 98.5% specificity and an AUROC of 0.63 (95% CI 0.53 to 0.72). Four symptoms and two dipstick results were independently associated with UTI, with an AUROC of 0.81 (0.72 to 0.90; validated 0.78) for symptoms, increasing to 0.87 (0.80 to 0.94; validated 0.82) with the dipstick findings. A high specificity threshold for the clean-catch model was more accurate and less costly than, and as effective as, clinical judgement. The additional diagnostic utility of dipstick testing was offset by its costs. The cost-effectiveness of the nappy pad model was not clear-cut.ConclusionsClinicians should prioritise the use of clean-catch sampling as symptoms and signs can cost-effectively improve the identification of UTI in young children where clean catch is possible. Dipstick testing can improve targeting of antibiotic treatment, but at a higher cost than waiting for a laboratory result. Future research is needed to distinguish pathogens from contaminants, assess the impact of the clean-catch algorithm on patient outcomes, and the cost-effectiveness of presumptive versus dipstick versus laboratory-guided antibiotic treatment.FundingThe National Institute for Health Research Health Technology Assessment programme.

Antibiotic Treatment—Much Better than Nothing

2019 ◽  
pp. 135-154
Author(s):  
Janet R. Gilsdorf
Keyword(s):  
Clinical Trials ◽  
Bacterial Meningitis ◽  
Antibiotic Treatment ◽  
Animal Experiments ◽  
Effective Management ◽  
Basic Principles ◽  
Duration Of Therapy ◽  
The Past ◽  
Drug Doses ◽  
Better Than

Over the past five decades, many animal experiments as well as clinical trials of antibiotics in humans treated for meningitis have defined the levels of antibiotics that are present in infected meninges and in the blood, thus informing the drug doses necessary to successfully treat the infection. In spite of the different kinds of bacteria that cause meningitis and the availability of various antibiotics to treat it, several basic principles of effective management for all common forms of bacterial meningitis have emerged from the decades of research. As a result of these studies, most children with meningitis in America receive appropriate antibiotic treatment (the correct antibiotic and the correct dose for the correct duration of therapy), and their outcomes are much, much better than the disastrous outcomes of earlier eras.

Bacterial meningitis antibiotic treatment

2017 ◽  
Vol 24 (12) ◽  
pp. S42-S45 ◽  
Author(s):  
R. Cohen ◽  
J. Raymond ◽  
L. Hees ◽  
D. Pinquier ◽  
E. Grimprel ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Antibiotic Treatment

scholarly journals Pediatric Bacterial Meningitis Prognosis and Antibiotic Treatment

2011 ◽  
Vol 85 (2) ◽  
pp. 150-154 ◽  
Author(s):  
Hiroshi SAKATA ◽  
Keisuke SUNAKAWA ◽  
Masato NONOYAMA ◽  
Yoshitake SATO ◽  
Tsunekazu HARUTA ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Antibiotic Treatment
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