F bacterial meningitis. Lancet 1997;336:708-16. three Drugs used within the therapy of infections. British National Formulary 1998;35:234. four Communicable Illnesses Surveillance Centre. Listeriosis. Commun Dis Rep CDR Wkly 1997;7:332. five Jones EM, MacGowan AP. Antimicrobial chemotherapy of human infection on account of Listeria monocytogenes. Eur J Clin Microbiol Infect Dis 1995;14:165-75.Use of dexamethasone remains contentious Editor–Mactier et al illustrate a vital complication of bacterial meningitis– namely, acute obstructive hydrocephalus.1 The authors say that they could not find any record of your incidence of this complication in kids. A alpha-Cyperone series of 79 circumstances more than 11 years in Australia has been published; it shows an incidence of 2.eight .two Interestingly, the first youngster Mactier et al described didn’t receive intravenous dexamethasone, whereas the child inside the second case did, but when the drug was started, or its function in treating acute obstructive hydrocephalus, was not pointed out. Despite the drug’s early promise, its use remains contentious. A recent meta-analysis showed that if it isAcute obstructive hydrocephalus complicating bacterial meningitisIn meningitis, one antibiotic is far better than than two Editor–A recent lesson in the week highlighted the possibility of meningitis in childhood presenting as obstructive hydrocephalus, with cerebrospinal fluid from ventriculostomy proving sterile but subsequent lumbar fluid yielding Streptococcus pneumoniae.1 Inside the two paediatric instances described, remedy consisted of both a third genera-BMJ VOLUME9 JANUARYwww.bmj.comLettersstarted with or ahead of parenteral antibiotics, dexamethasone can benefit young children with pneumococcal meningitis.3 However, there were limitations on the analysis undertaken. The usage of dexamethasone in meningitis clearly calls for further study, but questioning regardless of whether PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20185357 it must be made use of should really not delay the administration of intravenous antibiotics.Asrar Rashid Clinical fellow New South Wales Newborn and Paediatric Transport Service, Westmead, Sydney 2145, Australia1 Mactier H, Galea P, McWilliam R. Acute obstructive hydrocephalus complicating bacterial meningitis in childhood. BMJ 1998;316:1887-9. (20 June.) 2 Thomas DG. Outcome of paediatric bacterial meningitis 1979-1989. Med J Aust 1992;157:519-20. 3 McIntyre PB, Berkey CS, King SM, Schaad UB, Kilpi T, Kaura GY, et al. Dexamethasone as adjunctive therapy in bacterial meningitis. A meta-analysis of randomised clinical trials since 1988. JAMA 1997;278:925-31.will enhance outcome, it appears logical that the knowledge and information of those involved in neurological intensive care, particularly with regard to the management of raised intracranial pressure, altered cerebral perfusion, and autoregulation, should be out there for sufferers with bacterial meningitis. Unfortunately the lack of obtainable beds in such units inside the Uk might prevent these patients benefiting from modern day, targeted therapy.R Stephen Cooke Consultant neurosurgeon Victor Patterson Consultant neurologist Royal Victoria Hospital, Belfast BT12 6BA1 Mactier H, Galea P, McWilliam R. Acute obstructive hydrocephalus complicating bacterial meningitis in childhood. BMJ 1998;316:1887-9. (29 June.) two Horwitz SJ, Boxerbaum B, O’Bell J. Cerebral herniation in bacterial meningitis in childhood. Ann Neurol 1980;7: 524-8. three Roos KL, Tunkel AR, Scheld WM. Acute bacterial meningitis in youngsters and adults. In: Scheld WM, Whitley RJ, Durack DT, eds. Infection.