Approximately 25,000 cases of bacterial meningitis occur yearly in the United States. Attack rates are age specific, ranging from almost 400 per 100,000 in neonates to 1 to 2 per 100,000 in adults. Two-thirds of cases are in children. The mortality rate is about 5 percent in children beyond infancy, 25 percent in neonates, and 25 percent in adults.1,2 Long-term complications, such as cognitive deficits, epilepsy, hydrocephalus, and hearing loss, affect about a quarter of survivors. Prior to 1985, three species accounted for the majority of bacterial meningitis: Haemophilus influenzae (45 percent), Streptococcus pneumoniae (18 percent), and Neisseria meningitidis (14 percent). However, the specific cause of bacterial meningitis has changed in the era of vaccination against H. influenzae type b. From 1985 to 1991, the incidence of H. influenzae meningitis dropped 82 percent in children under 5 years old. Hence, S. pneumoniae and N. meningitidis have become the predominant causes of meningitis in children 1 month of age or older.3 Antibiotic resistance of S. pneumoniae to penicillins and ceftriaxone is becoming more prevalent in the United States. While such resistance has been encountered to date mostly in children, the clinician should consider modifying antibiotic selection for both children and adults with suspected pneumococcal meningitis (T§b.!®,...2.2Z-l). The following discussion focuses on bacterial meningitis in adults.
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