Skip to main content
SpringerLink
Log in

Acute Bacterial Meningitis

A Practical Guide to Treatment

  • Practical Therapeutics
  • Published:
CNS Drugs Aims and scope Submit manuscript

Summary

Recent advances in the treatment of bacterial meningitis have reduced the morbidity and mortality associated with this disease. These advances include the introduction of highly active and safe extended-spectrum cephalosporins and initial adjunctive therapy with dexamethasone. For such a life-threatening illness it is obvious that rapid diagnosis and optimum supportive care are of equal importance to antibacterial and anti-inflammatory therapies. Also, prevention by active immunisation represents an attractive strategy to reduce further the impact of purulent meningitis.

Third-generation cephalosporins, such as ceftriaxone and cefotaxime, are now preferred for initial therapy in most cases of bacterial meningitis. However, these agents are not active against listeria or enterococci. Moreover, pneumococcal strains resistant to both penicillin and extended-spectrum cephalosporins are becoming more prevalent.

The results of recent prospective, double-blind trials of dexamethasone adjunctive therapy show that this anti-inflammatory measure improves outcome from bacterial meningitis in infants and children, and should therefore be routine. For bacterial meningitis in neonatal and adult patients final recommendations for adjunctive therapy with dexamethasone must await results of ongoing studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Klein JO, Feigin RD, McCracken Jr GH. Report of the Task Force on diagnosis and management of meningitis. Pediatrics 1986; 78: 959–82

    PubMed  CAS  Google Scholar 

  2. Feigin RD, McCracken Jr GH., Klein JO. Diagnosis and management of meningitis. Pediatr Infect Dis J 1992; 11: 785–814

    Article  PubMed  CAS  Google Scholar 

  3. McCabe WR. Empiric therapy for bacterial meningitis. Rev Infect Dis 1983; 5: S74–S84

    Article  PubMed  Google Scholar 

  4. Schaad UB. Treatment of bacterial meningitis. Eur J Clin Microbiol 1986; 5: 492–7

    Article  PubMed  CAS  Google Scholar 

  5. Schaad UB, McCracken Jr GH, Loock CA, et al. Pharmacokinetics and bacteriologic efficacy of moxalactam, cefotaxime, cefoperazone, and ceftriaxone in experimental bacterial meningitis. J Infect Dis 1981; 143: 156–63

    Article  PubMed  CAS  Google Scholar 

  6. Odio CM, Faingezicht I, Salas JL, et al. Cefotaxime vs- conventional therapy for the treatment of bacterial meningitis of infants and children. Pediatr Infect Dis J 1986; 5: 402–7

    Article  CAS  Google Scholar 

  7. Peltola H, Anttila M, Renkonen O-L, et al. Randomised comparison of chloramphenicol, ampicillin, cefotaxime, and ceftriaxone for childhood bacterial meningitis. Lancet 1989; 1: 281–7

    Google Scholar 

  8. Schaad UB, Suter S, Gianella-Borradori A, et al. A comparison of ceftriaxone and cefuroxime for the treatment of bacterial meningitis in children. N Engl J Med 1990; 322: 141–7

    Article  PubMed  CAS  Google Scholar 

  9. Viladrich PF, Gudiol F, Linares J, et al. Characteristics and antibiotic therapy of adult meningitis due to penicillin-resistant pneumococci. Am J Med 1988; 84: 839–46

    Article  PubMed  CAS  Google Scholar 

  10. Friedland IR, Klugman KP. Failure of chloramphenicol therapy in penicillin-resistant pneumococcal meningitis. Lancet 1992; 339: 405–8

    Article  PubMed  CAS  Google Scholar 

  11. Friedland IR, Shelton S, Paris M, et al. Dilemmas in diagnosis and management of cephalosporin-resistant Streptococcus pneumoniae meningitis. Pediatr Infect Dis J 1993; 12: 196–200

    Article  PubMed  CAS  Google Scholar 

  12. Sloas MM, Barrett FF, Chesney PJ, et al. Cephalosporin treatment failure in penicillin- and cephalosporin-resistant Streptococcus pneumoniae meningitis. Pediatr Infect Dis J 1992; 11: 662–6

    PubMed  CAS  Google Scholar 

  13. Schaad UB, Nelson JD, McCracken Jr GH. Recrudescence and relapse in bacterial meningitis of childhood. Pediatrics 1981; 67: 188–95

    PubMed  CAS  Google Scholar 

  14. Lin T-Y, Nelson JD, McCracken Jr GH. Fever during treatment for bacterial meningitis. Pediatr Infect Dis J 1984; 3: 319–22

    Article  CAS  Google Scholar 

  15. Sáez-Llorens X, Ramilo O, Mustafa MM, et al. Molecular pathophysiology of bacterial meningitis: current concepts and therapeutic implications. J Pediatr 1990; 116: 671–84

    Article  PubMed  Google Scholar 

  16. Quagliarello V, Scheld WM. Bacterial meningitis: pathogenesis, athophysiology, and progress. N Engl J Med 1992; 327: 864–72

    Article  PubMed  CAS  Google Scholar 

  17. Täuber MG, Shibl AM, Haekbarth CJ, et al. Antibiotic therapy, endotoxin concentration in cerebrospinal fluid and brain edema in experimental Escherichia coli meningitis in rabbits. J Infect Dis 1987; 156: 456–62

    Article  PubMed  Google Scholar 

  18. Tuomanen E, Hengstler B, Rich R, et al. Nonsteroidal anti-inflammatory agents in the therapy of experimental pneumococcal meningitis. J Infect Dis 1987; 155: 985–90

    Article  PubMed  CAS  Google Scholar 

  19. Mustafa MM, Ramilo O, Mertsola J, et al. Modulation of inflammation and cachectin activity in relation to treatment of experimental Haemophilus influenzae type b meningitis. J Infect Dis 1989; 160: 818–25

    Article  PubMed  CAS  Google Scholar 

  20. Lebel MH, Freij BJ, Syrogiannopoulos GA, et al. Dexamethasone therapy for bacterial meningitis: results of two doubleblind, placebo-controlled trials. N Engl J Med 1988; 319: 964–71

    Article  PubMed  CAS  Google Scholar 

  21. Lebel MH, Hoyt J, Waagner DC, et al. Magnetic resonance imaging and dexamethasone therapy for bacterial meningitis. Am J Dis Child 1989; 143: 301–6

    PubMed  CAS  Google Scholar 

  22. Odio CM, Faingezicht I, Paris M, et al. The beneficial effects of early dexamethasone administration in infants and children with bacterial meningitis. N Engl J Med 1991; 324: 1525–31

    Article  PubMed  CAS  Google Scholar 

  23. Girgis NI, Farid Z, Mikhail I A, et al. Dexamethasone treatment for bacterial meningitis in children and adults. Pediatr Infect Dis J 1989; 8: 848–51

    Article  PubMed  CAS  Google Scholar 

  24. Kennedy WA, Hoyt MJ, McCracken Jr GH. The role of corticosteroid therapy in children with pneumococcal meningitis. Am J Dis Child 1991; 145: 1374–8

    PubMed  CAS  Google Scholar 

  25. Schaad UB, Lips U, Gnehm HE, et. al. Dexamethasone therapy for bacterial meningitis in children. Lancet 1993; 342: 457–61

    Article  PubMed  CAS  Google Scholar 

  26. Richter O, Ern B, Reinhardt D, et al. Pharmacokinetics of dexamethasone in children. Pediatr Pharmacol 1983; 3: 329–37

    CAS  Google Scholar 

  27. Wald E, and US Meningitis Study Group. Dexamethasone for children with meningitis [abstract]. In: Program and Abstracts of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy; 1992 Oct 12: Anaheim. No. 73: 123

  28. Kennedy WA, Hoyt MJ, McCracken Jr GH. The role of corticosteroid therapy in children with pneumococcal meningitis. Am J Dis Child 1991; 145: 1374–8

Download references

Author information

Authors and Affiliations

  1. Department of Paediatrics, University of Basel, Basel Kinderspital, PO Box, CH-4005, Basel, Switzerland

    Urs B. Schaad

Authors
  1. Urs B. Schaad
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schaad, U.B. Acute Bacterial Meningitis. CNS Drugs 2, 18–25 (1994). https://doi.org/10.2165/00023210-199402010-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00023210-199402010-00003

Keywords

Search

Navigation