AN AUDIT OF THE USE OF ANTIBIOTICS IN PRESUMED VIRAL MENINGITIS IN CHILDREN

The antibiotic management of 139 consecutive patients with presumed vi ral meningitis evaluated during a 6-month period was examined. The pre sumptive diagnosis of viral meningitis was made in retrospect by conse nsus among the authors, using clinical and routinely available laborat ory information. Sixty-eight (51.9%) of 131 patients with complete rec ords were treated with antibiotics after diagnosis, 25 for 2 days or l ess and 43 for longer than 2 days. Antibiotic treatment was retrospect ively judged to be unjustified in 35 (81.4%) of the 43 patients treate d for longer than 2 days. When compared with untreated patients antibi otic treatment was started in younger female children with lower cereb rospinal fluid glucose values and longer duration of symptoms. There w as no difference between the two groups in other cerebrospinal fluid v alues, peripheral white blood cell count or history of preceding antib iotics. In contrast no associations were found with treatment beyond 2 days, compared with treatment for 2 days or less. Thus the decision t o stop antibiotic treatment early did not appear to be made according to consistent clinical criteria. This apparent lack of consistent crit eria suggests the need to develop clinical guidelines for such decisio ns, both to aid clinicians and to provide standards for medical audit.