Fever interval before diagnosis, prior antibiotic treatment, and clinical outcome for young children with bacterial meningitis

In young children, meningitis due to Streptococcus pneumoniae is preceded b y a long interval from onset of fever to diagnosis of bacterial meningitis (hereafter known as "fever interval"), during which time the patient freque ntly contacts a clinician. By means of retrospective chart review, we compa red the fever interval that preceded diagnosis with the complication rate a mong 288 young children (age, 3-36 months) who had bacterial meningitis (19 84-1996), as stratified by causative organism and prior antibiotic treatmen t. Pathogens included S. pneumoniae, Haemophilus influenzae type b, and Nei sseria meningitidis. Pneumococcus species were associated with the longest fever interval prior to diagnosis of meningitis, the highest frequency of c ontact with a clinician before hospitalization, and the highest rate of doc umented morbidity or mortality. For S. pneumoniae, there was an association between antibiotic treatment received at prior meetings with a clinician a nd a reduced rate of meningitis-related complications (odds ratio, 0.14; P = .02). Antibiotic treatment during such meetings is associated with a subs tantial reduction in disease-related sequelae.