تعیین آنتی بیوتیک مناسب در مننژیت باکتریال کودکان بر اساس MIC

Background: Bacterial meningitis is one of the most serious infections in infants and children. Three organisms include S.PneumoN.meningH.Influ are the most common cause of meningitis in children between 2M-14y age.Etest is a new method for determination the MIC of some antimicrobial drugs in agarose .This method is useful for some organisms like as S .Pneumo N.mening H.Influsensitive Streptococcus and anaerobic aerobic gram negative. Materials and Methods: In this descriptive cross sectional study In 57 suspected meningitis children organisms isolated from blood CSF or other sterile boy fluid after culturing and antibiogram. .MIC of someorganisms detected by Etest method. Results: Streptococcuswas the most prevalent ( 70%) and S.pneumon( 90% of all Streptococcus) H.infl 2%N.mening 4%and L.monocyt 6%(more than expected)Gram negative (Ecoli Klebsiella entrobacter and psudomona) 18%. There was significant difference (P =0.01)in type of organisms between age groups. S.pneumonia was more frequent in children > 2 year N.meningitis in>4yr old .Site of isolation :blood CSF (35.8*28.3%)other sterile site 18.4%concomitant positive culture in two site:17%.Mean age in Streptococcus was significantly different with Listeria (p=0.05) N.meningitis (p=0.04)H.influ (p=0.04).but no difference with StaphylococcusKlebsiella and E.coli Two type of H.inf were sensitive to Ampici or chloram both of them were sensitive to ceftiaxon. GBS were sensitive to PNC or Ampici Strep.nonAnonBnon- Cotrimoxazol>32mic/ml /PNC >256mic/ml/ Vanco>256mic/ml Strep.D: Cotrimoxazol>0.062mg/ml/ /PNC >0.016mic/ml/Imipenem>0.032mic/ml. Strep Pneumonia: All fo them were sensitive except 3 cases /Cotrimoxazol>2ic/ml /PNC =0.01mic/ml/Vanco>0.125mic/ m Vanco>0. 25mic/ ml/.Cotrimoxazol>2ic/ml / PNC =0.01mg/ml Vanco>0.125mic/ ml / Cotrimoxazol>2mic/ml /MIC-PNC >0.016mic/ml Therefore high dose of PNC is adequate for S.pneu because of Interm resistance to PNC All 3 N.menin were sensitive to PNCChloraCeftria and vanco Resistant to all drugs and high MIC for cefotaximeCIPRO>32mic/ml. E coli: Pseudomona Aerogenosa:: Ceftriaxon>256mic/ml/ /Genta>0.038mg/ml Imipenem>32mic/ml. Klebsiella only Sensitive to Cipro Staph .Aureous:Sensitive to ClindaCiproChloraResistant toCeftPNCand Cotri Conclusion: Most type of N.meningitidisH.inf and S.pneumonia were sensitive to many drugs. Only minority of them were resistant to Ampicillin but sensitive to chloramphenicol and vice versa. limited number of pneumococcal resistance to penicillin is medium resistance( MIC:0.1-1) .we can treat this resistant type by increasing of penicillin dosage .The others were sensitive to all drugs. Therefore ampicillin and chloramphenicol are the drug of choice in empiric treatment of bacterial meningitis after neonatal period.