Anti-inflammatory therapy for bacterial meningitis - Rationale and practice

Despite considerable advances in the diagnosis and therapy of bacterial meningitis, the morbidity and mortality associated with this disease remain high. Research into the pathophysiology of bacterial meningitis suggests that the inflammatory response generated by the host is largely responsible for the deleterious consequences of the disease. Thus, effort is now being directed to identifying and investigating: (a) specific host factors contributing to this process, and (b) anti-inflammatory measures that may be safe and effective in the adjunctive therapy of bacterial meningitis. Adjunctive corticosteroids have been demonstrated to reduce the incidence of long term hearing loss and other neurological sequelae in the management of bacterial meningitis in children. It is not clear if the use of corticosteroids will have similar efficacy in adults or in neonates with bacterial meningitis. Research using animal models has also suggested other agents that may be effective in ameliorating the inflammatory response in bacterial meningitis, thereby possibly reducing the morbidity and mortality of this disease. This review describes the results of relevant investigations into the pathophysiology and management of bacterial meningitis, and provides recommendations for patient management based on this research.