Analysis of oral antibiotic treatment that failed to prevent the development of Haemophilus influenzae meningitis: consequences on mortality

One hundred and four children suffering from Haemophilus influenzae meningitis were studied in a multi-centre study in France between October 1991 and June 1993. The clinical and bacteriological findings were similar to those usually found in this condition. Fifty three per cent of the H. influenzae strains cultured produced β-lactamase and 98% were of type b. Forty-six children who had been prescribed oral antibiotics before hospitalisation were analysed in this study. This analysis took into account the nature of the antibiotic and whether it was prescribed as the treatment of first or second intention. Treatment failures, defined according to pre-established criteria, were found to be independent of whether or not the incriminated strain was β-lactamase producing and whether or not it was sensitive in vitro to the antibiotic prescribed. None of the 46 children who had received pre-hospital oral antibiotics died while three of the 58 who had not received pre-hospital oral antibiotics died. However, it is difficult to establish in our study a clear relationship between the reduction of mortality and previous oral antibiotic treatment in bacteriologically proven cases of H. influenzae meningitis.