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Current concepts in the treatment of staphylococcal meningitis
1Division of Infectious Diseases, Hartford Hospital, Connecticut 06115.
Abstract:
As natural host defences are suboptimal in cerebrospinal fluid (CSF), and since antibiotics often penetrate poorly into this body site, meningitis remains one of the most difficult infections to cure. When the responsible pathogen is killed only by a relatively high concentration of an antibiotic, or is susceptible only to drugs with moderate penetration into the CSF, then treatment becomes even more complicated. Therapy of staphylococcal meningitis poses all these problems, and is even further complicated by its frequent development in the presence of a foreign body, such as a ventriculoperitoneal or ventriculoatrial shunt. In this review, we discuss the various options open to the clinician in the treatment of meningitis caused by methicillin-susceptible and methicillin-resistant staphylococci, both in the presence and in the absence of a foreign device.
Insights
Treating staphylococcal meningitis is challenging due to poor antibiotic penetration into cerebrospinal fluid (CSF). This review explores treatment options for staphylococcal meningitis, with or without foreign devices.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Pharmacology
Background:
- Cerebrospinal fluid (CSF) has suboptimal host defenses, complicating meningitis treatment.
- Poor antibiotic penetration into the CSF exacerbates treatment challenges for meningitis.
- Staphylococcal meningitis is particularly difficult, especially with indwelling foreign devices like shunts.
Purpose of the Study:
- To review treatment strategies for staphylococcal meningitis.
- To address challenges posed by antibiotic penetration and foreign bodies in meningitis therapy.
- To discuss management of both methicillin-susceptible and methicillin-resistant staphylococcal meningitis.
Main Methods:
- Literature review of treatment options for staphylococcal meningitis.
- Analysis of factors influencing antibiotic efficacy in the CSF.
- Examination of treatment approaches in the presence and absence of foreign devices.
Main Results:
- Staphylococcal meningitis presents significant therapeutic hurdles due to CSF penetration issues.
- Foreign bodies, such as shunts, complicate treatment regimens for staphylococcal meningitis.
- Effective treatment requires careful consideration of antibiotic choice and device management.
Conclusions:
- Management of staphylococcal meningitis necessitates tailored antibiotic strategies.
- The presence of foreign devices requires specific considerations in treating staphylococcal meningitis.
- Optimizing antibiotic delivery and potentially removing foreign bodies are key to successful outcomes.