Rational antibiotics therapy in bacterial meningitis.

Acute bacterial meningitis is one of the most important causes of morbidity and mortality in developing countries. Though a wide range of antibiotics is available for therapy, judicious and rational use of antimicrobial agents needs to be ascertained. The choice of antimicrobial agents depends mainly on the age of the patient and its CSF penetrability. Neonatal meningitis is commonly caused by Gram Negative organisms such E. coli, Klebsiella and Pseudomans;Group B streptococciand Listeria, though other organisms like Staphylococcus sp. also contribute. The neonatal meningitis is best treated with a combination of amplicillin and a third generation cephalosporin given for 14-21 days. Post-neonatal meningitis usually occurs due to S. pneumoniae, N. meningitidis and H. influenzae and is best treated with third generation cephalosporins used with or without crystalline penicillin or ampicillin depending on the clinical situation. The therapy should be modified, if necessary, on availability of culture sensitivity report. The use of dexamethasone in meningitis due to the organisms other than H. influenzae still remains controversial.

Signal-averaged electrocardiography in survivors of first acute myocardial infarction: a pre-hospital discharge study.

Ninety one consecutive survivors of a first acute myocardial infarction (MI) were studied prior to hospital discharge, in order to observe the relationship of signal-averaged electrocardiography (SAECG) to thrombolytic therapy, site of infarction and left ventricular function. Sixty six patients received thrombolytic agents and the remaining had conventional therapy. The overall incidence of abnormal SAECG was 27 percent and 16 percent with high-pass 40 Hz and 25 Hz filters respectively. The SAECG (40Hz) was abnormal in 12 of 25 patients (48%) who did not receive thrombolytic therapy and in 13 of 66 (20%) who were thrombolysed (p < 0.01). When patients were classified according to the site of myocardial infarction, 6 out of 10 patients (60%) with anterior MI who were not thrombolysed had abnormal SAECG as compared to 10 of 51(20%) who received this treatment (p < 0.01), with no significant difference among inferior myocardial infarction patients. The mean (+/- SEM) ejection fraction (EF%) of anterior myocardial infarction patients was 31 +/- 3 percent in those with abnormal SAECG when compared to 39 +/- 2 percent in patients with normal SAECG (p < 0.05). Similarly, in patients with inferior myocardial infarction, the mean EF among these respective groups was 41 +/- 2 and 47 +/- 2 percent (p < 0.05). The mean echocardiographic score, which reflected regional LV wall motion abnormality, was not different between patients with anterior infarction when the groups with abnormal and normal SAECG were compared (9.1 +/- 0.6 versus 6.4 +/- 0.4), but differed significantly between inferior infarction patients (5.8 +/- 0.7 versus 4.6 +/- 0.4 respectively; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)