Bacterial Meningitis: A Review of 356 Cases with Special Reference to Corticosteroid and Antiserum Treatment

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Abstract
The treatment of bacterial meningitis in 356 patients admitted from 1960 to 1965 is reported. The overall mortality was 11%, i.e. unchanged from a previous review from the same hospital. The morbidity was unaltered, the meningococcal form remaining the most common though the incidence has decreased moderately. The frequencies of meningococcal, pneumococcal, and influenzal meningitis were 29, 21 and 18% respectively. The mortalities in the same groups were 1, 21 and 3%. No exact bacteriological diagnosis was established in 18% and the mortality in this group was 11%. One case of meningococcal meningitis caused by a sulphonamide-resistant type B meningococcus strain is reported. Alternate cases of pneumococcal meningitis were treated with corticosteroids in addition to the antibacterial chemotherapy. Of the 44 patients in the steroid-treated group 5 died, of the 37 patients in the control group 10 died (P = 0.127). Of 21 patients with bacteriaemia in the steroid-treated group 1 died, whereas 7 out of 23 bacteriaemic patients in the control group died (P = 0.064). The steroid-treated group includes more severe cases than the control group. As a consequence of these results, treatment with corticosteroids will in the future be used in this hospital in patients with pneumococcal meningitis. Of 64 patients with meningitis caused by type b Haemophilus influenzae 31 were treated with sulphonamide, streptomycin and type-specific antiserum, and 33 with sulphonamide and streptomycin alone. One death occurred in each group, the duration of the disease and the frequency of the sequelae were the same in the two groups. In the group without antiserum treatment, 5 cases of relapse during treatment were observed and one additional case has been observed since. They all responded well to chloramphenicol treatment. Serum will not be reintroduced, but chloramphenicol will be used instead of streptomycin in cases which do not respond satisfactorily.

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