Rational antibiotics therapy in bacterial meningitis

Acute bacterial meningitis is one of the most important causes of morbidity and mortality in developing countries. Though a wide range of antibiotics is available for therapy, judicious and rational use of antimicrobial agents needs to be ascertained. The choice of antimicrobial agents depends mainly on the age of the patient and its CSF penetrability. Neonatal meningitis is commonly caused by Gram Negative organisms such E. coli, Klebsiella and Pseudomans;Group B streptococciand Listeria, though other organisms like Staphylococcus sp. also contribute. The neonatal meningitis is best treated with a combination of amplicillin and a third generation cephalosporin given for 14-21 days. Post-neonatal meningitis usually occurs due to S. pneumoniae, N. meningitidis and H. influenzae and is best treated with third generation cephalosporins used with or without crystalline penicillin or ampicillin depending on the clinical situation. The therapy should be modified, if necessary, on availability of culture sensitivity report. The use of dexamethasone in meningitis due to the organisms other than H. influenzae still remains controversial.