Bacterial meningitis. Practical guidelines for management

Abstract

The therapy of bacterial meningitis has evolved over the past century. Initially, antimeningococcal antiserum was used to treat patients with meningococcal meningitis. During the 1930s, sulphonamides were the first antibiotics used in the treatment of bacterial meningitis. The use of other antibiotics followed in later decades. Insights into the pathophysiology of meningitis have led to the use of prophylaxis against infection, as well as adjunctive therapy aimed at attenuating the harmful sequelae, should infection occur. This article outlines the basic principles important in the selection of appropriate antimicrobials. the emergence of resistant organisms, specifically Streptococcus pneumoniae and Haemophilus influenzae, has necessitated changes in previously effective antimicrobial regimens. The availability of third generation cephalosporins has increased the survival rate for meningitis caused by Gram-negative bacilli. Research into the use of adjunctive steroids has led to the recommendation that these agents be used in the paediatric population, which traditionally has had a high prevalence of H. influenzae meningitis. The high efficacy of H. influenzae type b conjugate vaccine and the observation that steroids, by decreasing inflammation, also decrease CNS penetration of some drugs, has led to reconsideration of routine steroid use. Effective chemoprophylactic regimens for contacts of patients with either H. influenzae or Neisseria meningitidis can diminish the spread of infection. Vaccination for both immunocompetent and immunodeficient patients protects against disease caused by some of the more common meningeal pathogens.