Active substances: Azithromycin
+ free Zithromax pill.
Under most circumstances, the various forms of the conjugate vaccine can be used interchangeably 31.
Ad verse Effects No association with major adverse events have been reported in the first decade of use. Vaccine failures should be considered for immunological investigations.
Va ccine Impact The introduction of new vaccines had altered the epidemiology of meningitis over the last decades, mostly due to the introduction of the Hib vaccine conjugate 196, 235.
Immunization has almost eradicated invasive type b disease in those countries that have implemented national vaccination programs 196.
In The Netherlands, where vaccination was introduced in 1993, the incidence of invasive Hib disease among children younger than 5 years of age dropped from 28.
Economic studies, including cost-effectiveness analyses, provide another measure of vaccine impact. In developed countries, cost savings were accrued largely because of the long-term medical and institutional care costs resulting from Hib meningitis survivors with long-term sequelae such as hearing loss, cerebral palsy, and mental retardation.
Services for these outcomes in developing countries, however, are minimal or non-existent and thus no costs are saved. Even direct medical costs are relatively low and thus outweighed by vaccine costs.
As countries develop and provide greater services, Hib vaccine will become more cost effective even without a reduction in vaccine price. Where necessary all children should have their vaccinations brought up to date 135.
Ceftriaxone clears nasopharyngeal carriage and when used for treatment, eliminates the need for rifampicin prophylaxis in the index case.
Where a single child has meningitis in a day care centre the role of prophylaxis is controversial, one proposal is to give rifampicin to all unvaccinated children under two years old if contact has been for 25 hours or more per week or if a second case arises within 60 days 200.
Although a 1989 meta-analysis of all studies concluded that there was no benefit, scrutiny of selected studies from Dallas and Switzerland did show an advantage 232.In these regions there is an intensive care unit ICU acquired pneumonia, fifth as causes of ICU acquired affected 143 ICU acquired urinary tract infection 225. The classic clinical presentation is dramatic: association of the syndrome with alcoholism, although previously healthy people have been sputum.
In a large prospective study, the incidence of hearing loss was 3. Steroids must be commenced prior to the first dose of antibiotic 24. Cerebrospinal fluid parameters return to normal faster with dexamethasone treatment, yet dexamethasone does not affect cerebrospinal fluid sterilization or cephalosporin concentrations 232.
Dexamethasone therapy has been associated with rebound fever and carries a risk of significant bleeding in the absence of coagulopathy of 0.