Epidemic cerebrospinal meningitis

Treatment. Significant advances in the treatment of meningococcal M. achieved only after the introduction of the in medical practice of sulfonamides. Mortality in older children decreased to 5 - 12%. However, in children of early age results of such treatment were less effective and mortality in this age remained high (28-33%). The great success in the treatment of meningococcal M. and other sites of infection were obtained with the use of penicillin, especially in the early stages of the disease. Later on admission to hospital and late initiation of treatment considerably worsen the prognosis, as already in the first days of the disease, before the start of treatment, you may experience severe irreversible changes. Treatment Meters was held first in the form of intramuscular injections of penicillin in the amount of 300 000 IU a day for children up to 3 years of age and 500 000 IU a day at an older age. As the concentration of penicillin in the cerebrospinal fluid with the high number of antibiotic was not reached therapeutic levels, had advanced to enter penicillin in the subarachnoid space. Simultaneously with penicillin was introduced and sulfa drugs.
The described method of treatment Meters through the introduction of penicillin intramuscularly endolyumbalnoe in combination with sulfa drugs proved to be quite effective. But the side effects that occur in a number of cases in endolyumbalnom penicillin (deterioration of the General condition of the patient, klonico-tonic convulsions, sudden cyanosis, the cold sweat, the fall of cardiac activity, and even death), was forced to abandon this method of treatment. It was established that the necessary therapeutic concentration of penicillin in the cerebrospinal fluid can be obtained with the introduction of only penicillin by the intramuscular, but in large numbers. The required dose of penicillin for asendamine method of treatment Meters is equal to 200 000 IU a day for 1 kg of patient's weight.
In the most severe forms M. the number of penicillin can be increased up to 300 000 UNITS per 1 kg of weight. The daily dose of the antibiotic is administered in equal parts every 4 hours. Simultaneously with penicillin administered sulfonamides in the 0.3-0.4 g / day for 1 kg of patient's weight every four hours. The treatment results showed that, as a rule, already during the first day of the General condition improves, recovering consciousness, stop convulsions. On the 2nd or 3rd day of treatment, children begin to be interested in others, to play well there. To a 4-5th days of normal temperature and disappear meningeal phenomenon. To 7-9 th day normal cerebrospinal fluid.
In addition to medication, especially in protracted cases Meters, it is recommended that transfusion of blood in the quantity of 30 ml in infants and 40-60 ml in older children, only 3 to 4 transfusion with an interval of 4 days. When klonico-tonic convulsions using 0.2% solution of chloral hydrate in enemas: children under one year on W-4 tablespoons, the older children 2 spoons of 2% solution. If convulsions occur again, enema with 2% solution of chloral hydrate repeat. Simultaneously, it is recommended to apply luminal 0,01 - 0,015 g children up to 1 year, from 0,02 0,015 g - 3 years, 0,02-0,05 g at an older age by 2-3 times a day. In sharp headaches and other symptoms indicating increased intracranial pressure, it is necessary to intravenous injection, 40% glucose solution of 10-30 ml depending on the age of the child.
Diet and care. As the period of heavy and unconsciousness with meningococcal Meters with modern methods of treatment usually lasts a short time, ensuring the appropriate calorie food these days is not urgently needed. Only in cases where the condition is delayed, you need to ensure appropriate food of sufficient calorific values. Infants should receive breast milk and age-appropriate complementary foods. Food should be rich in vitamins, especially a and C. the oral Cavity it is necessary to clear 2 times a day, with mucus, accumulated in the nasopharynx, delete careful not to injure the mucous membrane. It is important to monitor shipments of the gastrointestinal tract. Delay chair, often observed with meningococcal M, recommended cleansing enema. In rare disorders of the kidneys in the urine is increasing protein and increased numbers of cells, and sometimes the increase of sugar content. These changes are in process of recovery.
When skin lesions may appear necrosis, which can be easily infected. Frequent change of underwear and bed linen, frequent toilet skin, daily baths can prevent possible complications.