A survey of current Israeli practices and approach to partially treated meningitis in children

Children with partially treated (PT) meningitis present diagnostic and therapeutic dilemmas. Since the approach to these children is not uniform, both in the literature and in daily practice, we conducted a survey among leading Israeli pediatricians from various hositals to learn about their opinions and practices relating to this problem. Twenty-eight of 30 senior pediatricians responded to a questionnaire encompassing the various aspects of PT meningitis. The results of the survey highlighted the confusion and lack of clear policy regarding the definition, diagnostic approach and treatment of these children. Fifty percent of the pediatricians stated that even one dose of an antimicrobial agent, regardless of the type of drug, is sufficient for the definition of PT meningitis; 43% of the responders did not require any threshold parameter in CSF findings for the definition of probable bacterial meningitis among PT children and 52% did not think that a second lumbar puncture was useful as a diagnostic aid in PT meningitis. Epidemiological circumstances played a role in the diagnostic and therapeutic approach of infectious disease specialists mainly, but less so in the other groups of pediatricians. Finally, more than half the responders did not use throat cultures to identify potential carriers among PT meningitis patients and did not consider the use of prophylactic treatment in close contacts. These data clearly indicate the need for guidelines regarding the various aspects of PT meningitis.