The outcome of non-typhoidal salmonella meningitis in Malawian children, 1997-2006

Ann Trop Paediatr. 2009 Mar;29(1):13-22. doi: 10.1179/146532809X401980.


Introduction: The clinical course and outcome of non-typhoidal salmonella (NTS) meningitis in Malawian children over a 10-year period (1997-2006) is described.

Methods: Demographic, clinical and laboratory data were collected for all children over 2 months of age admitted with salmonella meningitis to Queen Elizabeth Central Hospital from 1997 to 2006. In the 1st year, salmonellae were susceptible to chloramphenicol, and children received 2 weeks of chloramphenicol treatment. When NTS resistance to chloramphenicol started to appear in 1998, treatment was changed to ceftriaxone. From 2002, the duration of antibiotic therapy was extended to 4-weeks which included 2 weeks of intravenous ceftriaxone and a further 2 weeks of oral ciprofloxacin.

Results: The in-hospital case fatality rate (CFR) was 52.3% (48.2% until 2002 and 53.9% after prolonged antibiotic therapy was introduced). Of the survivors, one in 12 (8.3%) became completely well (sequelae-free) in the period 1997-2001 while 18 of 31 survivors (58.1%) made a complete recovery during 2002-2006 (p<0.01). After the 4-week course of antimicrobial therapy was introduced, the number of relapses or recurrences fell from nine in 15 (60%) survivors treated with chloramphenicol or ceftriaxone to three in 35 (8.7%) survivors who received 4 weeks of antibiotics (p<0.0001).

Conclusion: In Malawi, salmonella meningitis has a CFR of approximately 50%, which has remained constant over many years. Residual morbidity, however, has decreased over 10 years, despite rising numbers of multi-drug-resistant cases of NTS. This improvement might be owing to better treatment and management and/or reduced pathogenicity of the multi-drug-resistant bacteria.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Ceftriaxone / therapeutic use
  • Child
  • Child, Preschool
  • Chloramphenicol / therapeutic use
  • Ciprofloxacin / therapeutic use
  • Double-Blind Method
  • Drug Resistance, Bacterial
  • Drug Therapy, Combination
  • Humans
  • Infant
  • Meningitis, Bacterial / drug therapy*
  • Meningitis, Bacterial / microbiology
  • Nutritional Status
  • Prognosis
  • Prospective Studies
  • Recurrence
  • Salmonella Infections / drug therapy*
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Ciprofloxacin
  • Chloramphenicol
  • Ceftriaxone