The Efficacy of Vancomycin and Steroid Therapy for the Treatment of Bacterial Meningitis in Children - a Research Study
Bacterial Meningitis in Children - a serious disease - inflammation of the meninges (the three membranes - dura mater, arachnoid, and pia mater that line the skull and vertebral canal and enclose the brain and spinal cord), caused by viral or bacterial infection. If not treated adequately can result in neurological complications including hearing loss, seizures, cognitive impairment, sensory motor impairment and others.
The patient group includes children under the age of 16 without other serious medical conditions. The study considered a retrospective analysis of paediatric patients with bacterial meningitis who were admitted to Chonbuk National University Hospital between January 2005 and December 2015. 10 paediatric patients (5 boys and 5 girls) participated and their median age was 6.5 months and all patients were diagnosed with bacterial meningitis.
All patients were treated with intravenous Vancomycin (60 mg/kg/day) and Cefotaxime (200 mg/kg/day) as an initial treatment. Vancomycin belongs to a class of medications called glycopeptide antibiotics and is used against resistant bacterial strains of streptococcus and staphylococcus. Cefotaxime is a third-generation cephalosporin antibiotic with a broad spectrum activity against gram positive and gram negative bacteria.
Treatment Intervention for Bacterial Meningitis in children
Treatment with combined Vancomycin and steroid therapy.
Steroids are synthetic drugs that closely resemble cortisol, a hormone that the body's adrenal glands produce naturally.
Steroid therapy interventions appear to reduce the incidence of hearing loss and neurological complications according to some research studies. However, there are other studies that indicate that the use of steroids can block the penetration of Vancomycin into brain parenchyma (the functional tissue of an organ).
Therefore, it is important to identify the efficacy of the combined Vancomycin and steroid therapy. Five out of the 10 patients responded well to the Vancomycin treatment (50%).
The impact of steroid treatment on Vancomycin efficacy appears to be that higher steroid dosage impacts adversely on Vancomycin effectiveness.
Comparison between low and high dose of steroid treatment for Bacterial Meningitis in children
Steroid treatment can supress the inflammation in the brain parenchyma but is controversial due to the large number of complications and the reduction of Vancocymin efficacy.
The low dose steroid group had a 66.6% response rate to Vancomycin while the high steroid dose had no response. However, when the non-responsive patients were administered Teicoplanin combined with an identical steroid combination, they responded well.
Teicoplanin is a semisynthetic glycopeptide antibiotic used in the prophylaxis and treatment of serious infections caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus and Enterococcus faecalis.
Outcome
Despite the limitations of this study, namely its retrospective nature, the small number of patients, the study showed that high dosage of steroids may affect adversely the effectiveness of Vancomycin to treat bacterial meningitis in children.
The practical consequence is that medical professionals should be careful when maintaining steroid therapy for Bacterial Meningitis and the use of steroids should be administered taking into account the child’s condition.
Bibliography
Infect Chemother. 2017 Dec 49(4), Response of Vancomycin according to Steroid Dosage in Pediatric Patients with Culture-Proven Bacterial Meningitis