[Bacterial meningitis - diagnosis and treatment]

Area of Science:

• Infectious Diseases
• Neurology
• Microbiology

Background:

• Bacterial meningitis diagnosis and treatment evolve due to new insights into pathophysiology and antimicrobial resistance.
• Understanding etiologic agents and their prevalence across age groups is key for effective management.

Purpose of the Study:

• To review current concepts in bacterial meningitis diagnosis and treatment.
• To discuss etiologic agents, pathophysiology, and therapeutic options including antimicrobial, anti-inflammatory, and supportive care.

Main Methods:

• Comprehensive bibliographic review of MEDLINE articles from the last ten years.
• Inclusion of a classic article and relevant infectious disease textbook chapters.

Main Results:

• Empirical antibiotic therapy is guided by age-specific probable etiologic agents.
• CSF analysis, including Gram stain and culture, aids diagnosis, though antigen tests have low sensitivity.
• Common neonatal agents include E. coli, Streptococcus B, and L. monocytogenes; post-neonatal agents are increasingly S. pneumoniae and N. meningitidis due to decreased H. influenzae b incidence.
• Third-generation cephalosporins (ceftriaxone/cefotaxime) are preferred antibiotics, often combined with ampicillin in neonates.
• Dexamethasone shows efficacy in reducing inflammation and sequelae, particularly auditory.
• Fluid restriction offers no supportive care advantage.

Conclusions:

• Early diagnosis and prompt treatment significantly correlate with favorable patient outcomes.
• Evolving understanding of pathophysiology, novel antibiotics, and rising bacterial resistance necessitate updated treatment protocols for bacterial meningitis.