METHODS: A questionnaire invoking the specialists' preferred choices in treating
bacterial meningitis was circulated by e-mail in March 1999 to 41 paediatric
infectious diseases specialists or microbiologists (Paediatric Investigators Collaborative Network on
Infections in Canada [PICNIC] members) who practised in 13 paediatric centres located in eight provinces.
RESULTS: Thirty-two (78% response rate) replies were received by July 1999 from 11 paediatric centres in seven provinces.
Dexamethasone was recommended by 11 of 32 (34%) respondents for suspected S pneumoniae, four of 32 (12%) for suspected N
meningitides, 18 of 32 (56%) for suspected H influenzae type b and five of 32 (16%) for suspected PT
meningitis. A trend for more frequent recommended use of
dexamethasone for S pneumoniae, H influenzae type b and N
meningitides meningitis was found in eastern provinces (Ontario, Quebec and Nova Scotia), as opposed to the western provinces (Manitoba, Saskatchewan, Alberta and British Columbia). The most commonly recommended first line empirical
antibiotic therapy was
vancomycin plus 3rd-generation
cephalosporin (V+3C). This was recommended by 27 of 32 (84%) respondents for suspected S pneumoniae, seven of 32 (22%) for suspected N
meningitides, six of 32 (19%) for suspected H influenzae type b and 24 of 32 (75%) for PT
meningitis; the remainder recommended using a 3C empirically for each type of
meningitis. The major reason cited by respondents for using V+3C for suspected S pneumoniae was the presence of high-and intermediate-level
penicillin-resistant S pneumoniae in their centres. No differences were found in the choice of
antibiotic(s) between practitioners in the eastern and western provinces.
CONCLUSIONS: