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Sir.—I could not help being struck by the final comments of Goldenberg and Neter in "Meningitis Due to Two Serotypes of Escherichia coli" (Am J Dis Child 131:213, 1977). While it is difficult to dispute their conclusion that "had ampicillin been used initially for the treatment of meningitis, this unique case of dual E coli infection probably would have escaped detection," it is not difficult to take exception to their apparent exultation in their discovery.
After all, two weeks of continued bacterial viability in the CSF of a severely ill infant with purulent meningitis, despite antibiotic therapy, when another antibiotic would have proved effective (and finally did) is a cause for profound sorrow despite the patient's "recovery."
What this report underscores is the necessity for sterilizing the CSF within 24 to 48 hours, and, failing this, to switch promptly to another antibiotic irrespective of initial laboratory data suggesting that
JACOBSTEIN RA. Meningitis. Am J Dis Child. 1977;131(10):1173-1174. doi:10.1001/archpedi.1977.02120230119026