The evaluation and management of bacterial meningitis: current practice and emerging developments

Bacterial meningitis is a serious neurologic illness with significant morbidity and mortality if not recognized and treated promptly and appropriately. The presentation and management are influenced by host factors and the pathogenic organism; the purpose of this review is to highlight those differences and to survey the literature on current practices and emerging developments in evaluation and management.

Clinicians must have a high index of suspicion for bacterial meningitis. The classic symptoms of bacterial meningitis are fever, neck stiffness, altered mental status, and headache. Certain patient populations, such as the young and the immunocompromised, may have a blunted presentation, and for these patients, clinicians must have an especially low threshold for obtaining a lumbar puncture. When bacterial meningitis is suspected, antibiotic therapy should be initiated as soon as possible because early treatment is associated with a better outcome. In addition, the use of the corticosteroid dexamethasone has been shown to be helpful as an adjuvant therapy in specific clinical situations. New adjuvant therapies are being developed to lower the high rate of complications that currently occur in patients with bacterial meningitis.

Recent studies have altered the evaluation and management of bacterial meningitis. In addition, they have elucidated the mechanisms through which bacterial meningitis causes complications and have identified new targets for treatment.