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Adjunctive therapy in bacterial meningitis--what make sense?
1Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510.
Abstract:
Bacterial meningitis continues to cause morbidity and mortality despite bactericidal antibiotic therapy. Experimental studies of pathophysiology reveal the bacteria and their surface components within cerebrospinal fluid (CSF) induce the release of inflammatory cytokines that promote CSF inflammation, injure the cerebral microvasculature and cause brain edema. Adjunctive corticosteroids reduce inflammation, ameliorate the pathophysiology, and improve neurologic outcome in children. Practical recommendations are made for children and selected adults regarding current and future directions of adjunctive therapy.
Insights
Bacterial meningitis treatment can be improved. Adjunctive corticosteroids help reduce inflammation and improve outcomes in children with bacterial meningitis.
Area of Science:
- Neurology
- Infectious Diseases
- Pharmacology
Background:
- Bacterial meningitis causes significant morbidity and mortality, even with antibiotic treatment.
- Pathophysiology involves inflammatory cytokines, cerebrospinal fluid (CSF) inflammation, microvasculate injury, and brain edema.
- Adjunctive corticosteroids show promise in mitigating these effects.
Purpose of the Study:
- To review the role of adjunctive corticosteroids in bacterial meningitis.
- To discuss current and future therapeutic directions for adjunctive therapy.
Main Methods:
- Review of experimental pathophysiology studies.
- Analysis of clinical outcomes in children and adults.
Main Results:
- Corticosteroids reduce inflammation and ameliorate meningitis pathophysiology.
- Adjunctive corticosteroids improve neurologic outcomes in pediatric patients.
Conclusions:
- Adjunctive corticosteroid therapy is beneficial in managing bacterial meningitis.
- Recommendations are provided for pediatric and selected adult patients regarding current and future adjunctive treatments.