PURULENT MENINGITIS : PRINCIPLES AND RESULTS OF REVISED STANDARDIZED TREATMENT IN 281 CASES

Summary This paper describes the methods and results of standardized treatment of 281 patients with purulent meningitis. In treating these patients, antibiotics were administered intramuscularly, but not intrathecally whatever the causal organism or the severity of meningitis, the intravenous administration of fluids was avoided and corticosteroids were used as an adjunct to antibiotics. The intramuscular injection of penicillin and chloramphenicol formed the initial treatment, which was varied subsequently according to the causal agent and the likelihood of associated infection such as pneumonia. The importance of the prevention or treatment of relatively common complications, such as airway obstruction and mixed infections in “open” sites, is emphasized. Cranial surgical procedures were avoided : exploration of the subdural space was considered unnecessary. In general, attempts were made to reduce management to the simplest essential measures, particularly in the case of infants, excessive handling of whom may lead to poor results. The overall mortality rate in 281 patients with purulent meningitis was 3·2%. Amongst patients with pneumococcal meningitis, the mortality rate was 7·1%. Other rates were as follows : Hamophilus influenza meningitis, 2·7% ; meningococcal meningitis, 1·4% ; unidentified purulent meningitis, 2%. The ages of the patients are grouped in relation to the causal organisms and mortality. Subsequent review of these patients has shown that serious sequeke are infrequent and almost confined to pneumococcal meningitis. Patients with purulent meningitis who have a prior history of head injury should receive penicillin prophylactically after apparent cure of the meningitis.