Abstract
Prehospital diagnostics and therapeutic management, as well as clinical and laboratory data from 57 consecutive cases with otogenic pneumococcal meningitis (OPM) in Denmark during a 2-y period (1999-2000) were studied by review of discharge and medical records including a questionnaire sent to the general practitioners responsible for the individual patient. 12 cases were <2 y of age, whereas the remaining 45 cases were >21 y of age. Fever (in 98%) and altered consciousness (in 98%), respectively, were significantly more frequent prehospital symptoms (median duration of symptoms: 2 d (1-4)) than earache (in 71%, p < 0.0001), tympanic perforation (in 38%, p < 0.0001), and back rigidity (in 25%, p < 0.0001) in OPM. Some 82% visited a physician before admission, and an otogenic focus was diagnosed in 57%, a myringotomy was performed in 12%, and antibiotic therapy was initiated in 29% of these cases. Prehospital antibiotic therapy was more likely to be initiated in patients where the physician found an otogenic focus compared to patients where an otogenic was not found (46% vs 6%, respectively, p = 0.01). However, <10% of cases with OPM were treated for otitis media with adequate dosing of antibiotics for more than 1 d based on pha...Continue Reading
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