Abstract

PARTIALLY TREATED BACTERIAL MENINGITIS; THE DILEMMA CONTINUES

Groob Alkhayer, Maiass El Homsi and *Mhd Nezar Alsharif

ABSTRACT

Objective: This study aimed to determine the effect of pretreatment
with antibiotics before lumbar puncture on cerebrospinal fluid
profile(CSF) compared with the CSF results’ of patients who were not
pretreated with antibiotics. Methods: This is a retrospective study
composed of 55 children (newborns until 12 years old); who reviewed
the Children University Hospital Between 1/1/2015 and 20/11/2017
and were diagnosed with acute bacterial meningitis. Results: A total of
55 children were diagnosed with acute bacterial meningitis and were
included in this study. However only 23.6% (13 cases) of all patients
received antibiotics before cerebrospinal fluid analysis (CSF) and those
were studied to determine the changes due to the pretreatment. Those patients (13 patients)
CSF results’ revealed decreased WBC (white blood cell count) in 38.4% of them, lymphocyte
dominance in 61.5% of them, 62% of their culture results were sterile, high glucose levels in
38.4% cases and low protein levels in (23% of them). Ceftriaxone was the most common
antibiotic given in this study and it caused significant differences in the CSF profile.
Conclusion: We cannot dogmatize that prior treatment may cause a complete change in the
CSF analysis results, and suggest a diagnosis of another form of meningitis based on the CSF
profile, but we are confident that the inappropriate pre-treatment will blur the diagnosis of
bacterial meningitis and make it harder to establish.

Keywords: Acute bacterial meningitis; antibiotic pretreatment; CSF analysis.