Diagnosis and treatment of bacterial meningitis

In the clinical approach of bacterial meningitis, the following points are stressed. Rapid identification of the germ, pending the results of the cultures. Various laboratory procedures are reviewed such as the Gram stain, the counterimmunoelectrophoresis, lactate determination and limulus assay of the CSF. Because of the local impaired host defences as well as the poor penetration and partial bioinactivation of most of the antibiotics in the CSF, large doses of the drugs are necessary to ensure sufficient levels and bactericidal titers. Specific antimicrobial therapy of meningitis is reviewed, with an emphasis on the third generation cephalosporins which appears to be the key to the treatment of Gram negative infections.