ACUTE BACTERIAL-MENINGITIS - A PRACTICAL GUIDE TO TREATMENT

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.