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Slide 13 In developed countries significant changes have occurred over the last decade as to the choice of antibiotics due to susceptibility patterns in their area. Fortunately, in the Philippines, resistance to chloramphenicol and ampicillin is not yet a major problem. It is recommended that the first drugs may still be used. Also the expense of utilizing 3rd generation cephalosporins is usually beyond the capacities of most Filipino families.

Slide 14 For S. pneumoniae in Asia, the percentage of penicillin resistance ranges from 2.6% to 35%. In the Philippines there has been an slight increase in the penicillin resistant strains . Unfortunately only a small percentage were subjected to confirmation by MIC thus the true extent of the problem is still unknown.

Slide 15 The treatment of bacterial meningitis caused by gram negative bacilli has been revolutionized by the availability of 3rd generation cephalosporins. However, treatment of these infections have been made more difficult by the appearance of beta-lactamase producing bacteria which are capable of hydrolyzing 3rd generation cephalosporins. Resistance rates for gram negative bacilli have been increasing in the Philippines but this varies from region to region. Thus, physicians should base their treatment recommendations for these organisms on their region's prevailing resistance patterns.

Slide 16 + 17 The following tables are the current recommendations by the Task Force of Meningitis based on available local data for empiric therapy of bacterial meningitis prior to availability of CSF results. Alternative therapies may be used if there is an allergy to the first line drugs or resistance is suspected.

Slide 18 Once CSF gram stain or culture results are available, the following are the recommended antimicrobials to be given. 1Cefotaxime or Ceftriaxone

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