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Bacterial meningitis: current controversies in approaches to treatment
1Department of Paediatric Infectious Diseases, St Mary's Hospital, London, UK.
Abstract:
Acute bacterial meningitis continues to be a disease with unacceptably high mortality and morbidity rates in both adults and children worldwide, despite advances in antibacterial therapy. Death or permanent disability occurs frequently. The causative organism varies with age, immune function and immunisation status. Infection with Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) is associated with the majority of cases, with Listeria monocytogenes and Streptococcus agalactiae being more prevalent pathogens at the extremes of age (<3 months or >50 years). Antibacterial resistance is an increasing problem, particularly in pneumococcal bacteria but increasingly in other organisms. The increasing prevalence of resistance of pneumococcus to penicillin and the cephalosporins complicates therapy and may have an important impact on treatment outcome. Increased understanding of the pathophysiology has allowed advances in diagnosis and therapy. The use of adjunctive corticosteroids remains controversial, but is probably beneficial in reducing neurological sequelae in children. In adults the evidence is less clear. Vaccination has virtually eradicated Hib meningitis in some countries. Recent introduction of a conjugate vaccine against serogroup C meningococci in the UK has caused a dramatic reduction in the incidence of invasive disease due to this organism. A 7-valent pneumococcal vaccine promises a similar reduction in the incidence of invasive pneumococcal disease. In the meantime, the emergence of widespread resistance of organisms to antibacterial agents, in particular among the common organisms causing bacterial meningitis, remains the biggest challenge in therapy.
Insights
Acute bacterial meningitis remains a critical global health threat with high mortality and morbidity. Antibiotic resistance, particularly in Streptococcus pneumoniae, presents the biggest therapeutic challenge.
Area of Science:
- Infectious Diseases
- Microbiology
- Neurology
Background:
- Acute bacterial meningitis causes significant global mortality and morbidity in children and adults.
- Key pathogens include Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae type b (Hib), with variations by age and immune status.
- Antibiotic resistance, especially in Streptococcus pneumoniae, complicates treatment and impacts outcomes.
Purpose of the Study:
- To review the current landscape of acute bacterial meningitis, including causative agents, challenges, and therapeutic advancements.
- To discuss the impact of antibiotic resistance on meningitis treatment strategies.
- To evaluate the role of vaccination and adjunctive therapies in managing bacterial meningitis.
Main Methods:
- Literature review of studies on bacterial meningitis epidemiology, pathophysiology, diagnosis, and treatment.
- Analysis of data on antibiotic resistance patterns for common meningitis pathogens.
- Evaluation of evidence for adjunctive therapies like corticosteroids and the impact of vaccines.
Main Results:
- Vaccination has significantly reduced Haemophilus influenzae type b (Hib) and serogroup C meningococcal meningitis incidence.
- Antibiotic resistance, particularly penicillin and cephalosporin resistance in Streptococcus pneumoniae, is a growing concern.
- The efficacy of adjunctive corticosteroids is clearer in children (reducing neurological sequelae) than in adults.
Conclusions:
- Despite advances, bacterial meningitis remains a serious disease, with antibiotic resistance posing the primary therapeutic challenge.
- Vaccination strategies have proven effective in reducing the incidence of specific types of bacterial meningitis.
- Further research is needed to optimize treatment protocols and combat emerging antibiotic resistance in meningitis management.