Bacterial Meningitis

Initial empiric therapy for community-acquired bacterial meningitis should be based on the possibility that penicillin-resistant pneumococci may be the etiologic organisms and, hence, should include a combination of third-generation cephalosporin (cefotaxime or ceftriaxone) and vancomycin. Ampicillin should be included if the patient has predisposing factors that are associated with a risk for infection with Listeria monocytogenes. Bacterial isolates from the cerebrospinal fluid should be tested for antimicrobial susceptibility. Understanding the significance of inflammatory cytokines in the pathophysiology of bacterial meningitis leads to an understanding of the need to prevent their formation. Dexa- methasone inhibits synthesis of the inflammatory cytokines, interleukin-1 and tumor necrosis factor. Results of clinical trials and meta-analysis suggest that dexamethasone therapy improves the outcome for patients with bacterial meningitis. Dexamethasone should be administered before or with the first dose of antibiotics. The development of therapeutic modalities to downregulate host inflammatory responses, such as those of monoclonal antibodies to cytokines, is of utmost importance.