Bacterial meningitis needs to be treated like this

Bacterial meningitis is an extremely harmful disease, especially for children, as it can easily cause various sequelae if not treated in time. From the perspective of clinical effects, general treatment, antibacterial drug treatment, cerebral hyponatremia treatment, subdural effusion treatment, and increased intracranial pressure treatment have good therapeutic effects.

1. General treatment

Lie quietly in bed, pay attention to disinfection and isolation, keep the airway open, give oxygen, and suction sputum. For anticonvulsants, diazepam 0.1-0.2 mg/kg can be used intravenously (up to 10 mg each time); phenobarbital sodium 5-7 mg/kg can be injected intramuscularly and intravenously, half of each dose; phenytoin sodium 6 mg/kg can be injected intravenously, which can be repeated if necessary and changed to oral administration as soon as possible; paracetamol 0.3 ml/kg can be administered by enema.

2. Antimicrobial therapy

(1) Influenza B: Use ampicillin 400 mg/(kg.d), divided into 6 intravenous doses. Stop the drug 5 days after the fever subsides. The course of treatment is 10 to 14 days. Or stop the drug when the lymphocytes in the cerebrospinal fluid are <50×106/L and the protein is <500 mg/L after a full course of treatment. Chloramphenicol 50-100 mg/(kg.d), divided into 2 intravenous injections, the course of treatment is 7 days.

(2) Pneumococcus: Penicillin 800,000-1,000,000 U/(kg.d) by intravenous drip, ampicillin 150-400 mg/(kg.d) or erythromycin 50-60 mg/(kg?d) by intravenous drip in divided doses. If the patient is allergic to penicillin, cephalosporin 80 mg/kg may be used instead, divided into 4 doses for intravenous injection, plus intrathecal injection of 5-25 mg/d.

(3) Staphylococcus: ceftriaxone. Penicillin is used for sensitive strains, and ceftriaxone is injected intrathecally.

(4) Pathogen is unknown: Ampicillin. If the patient is allergic to penicillin, chloramphenicol can be used instead.

3. Treatment of cerebral hyponatremia

If serum sodium is <120mmol/L and there are symptoms of hyponatremia, 12ml/kg of 3% sodium chloride can be dripped intravenously within 2 to 3 hours. This amount can increase serum sodium by about 10mmol/L and can be repeated after a few hours if necessary.

4. Treatment of subdural effusion

If early cranial bone transillumination or CT examination reveals fluid accumulation but no symptoms of increased intracranial pressure, puncture treatment is not necessary. If there is a lot of fluid accumulation and symptoms of increased intracranial pressure, puncture can be performed. Puncture should be performed daily at first, and no more than 30 ml of fluid should be extracted each time. Then puncture should be performed every other day until the fluid accumulation is drained. It will usually be cured within 2 weeks. If the symptoms do not improve after 3 to 4 weeks, or the amount of fluid is too much and puncture and fluid extraction cannot relieve the symptoms of intracranial hypertension, drainage can be continued. If it is still ineffective, surgical removal of the capsule can be considered.

5. Management of increased intracranial pressure

20% mannitol or 25% sorbitol 1-2g/kg, quickly administered intravenously within 20-30 minutes, supplemented with 50% glucose solution 1/8-12 hours, can be used 2-3 times, and the course of treatment is generally 2 days. Or use 30% urea solution (diluted with 10% sorbitol). Maintenance therapy can be achieved with glycerol 1-2 g/kg, 1/4-6 hours, orally or by nasogastric feeding.

6. Prevent spinal canal obstruction

For patients with thick cerebrospinal fluid or late treatment, intravenous drip of hydrocortisone or dexamethasone, or intrathecal injection of dexamethasone 1-2 mg can improve the efficacy.