The emergence of resistant XXXX --implications for empiric therapy.

@entity1 @entity2176 @entity7706 @entity4008 @entity114 @entity5898 @entity2506
BACKGROUND: Following the emergence of @entity114 and @entity5898 resistant @entity2506 in the United States, inclusion of @entity2176 in empiric therapy for all suspected @entity4008 was recommended by the American Academy of Pediatrics. Few data are available to evaluate this policy. AIMS: To examine the management and clinical course in relation to antibiotic therapy of a large unselected cohort of @entity1 with @entity2506 in a geographic area where antibiotic resistance has recently increased. METHODS: Retrospective review of all cases of @entity2506 in a defined population (Sydney, Australia), 1994-99. RESULTS: A total of 104 cases without predisposing illnesses were identified; timing of lumbar puncture (LP) was known in 103. Resistance to @entity114 increased from 0 to 20% over the study period. Only 57 (55%) had an early LP (prior to parenteral antibiotics); 55 (96%) had organisms on Gram stain. Severe disease (intensive care admission or death) increased significantly from 57 cases with early LP (28%) to 33 with delayed LP (42%) to 13 with no LP (62%). Evidence of @entity7706 was available within 24 hours in 85% of those with delayed or no LP. Outcome was not related to empiric @entity2176 use, which increased from 5% prior to 1998 to 48% in 1999. CONCLUSION: LP is frequently delayed in @entity2506 . Based on disease severity, empiric @entity2176 is most justified when LP is deferred. If an early LP is done, @entity2176 can be withheld if Gram positive diplococci are not seen.
