[Current views on the pathophysiology of bacterial meningitis--new therapeutic possibilities?]

Despite the introduction of numerous antimicrobial therapeutic advances, the morbidity and mortality associated with bacterial meningitis remain high. New understanding of the pathogenesis and molecular pathophysiology of bacterial meningitis have led to the development of innovative, adjunctive treatment strategies in the hopes of improving outcome from this disorders. Studies in animal models have demonstrated, that the inflammatory response resulting from bacterial invasion of the subarachnoid space is due in large part to the activity of host-derived mediators (cytokines). This inflammatory response is responsible for the long-term neurological sequelae and death associated with bacterial meningitis. Experimental studies have demonstrated, that attenuation of the inflammatory response by anti-inflammatory agents may be useful in preventing many of the pathophysiologic consequences of bacterial meningitis. Numerous potential therapeutic agents, that may limit inflammation of the subarachnoid space have been and are being developed, and trials in animal models and in humans are under way. There are: corticosteroids (dexamethasone), non-steroidal anti-inflammatory agents, pentoxifylline, anti-leukocyte CD-18 receptor antibodies, specific cytokine antagonists, antagonists of Platelet-Activating Factor (PAF) and others. Safe and effective agents with demonstrated efficacy as adjuvants to bactericidal antimicrobial agents in the therapy for bacterial meningitis in humans may improve the prognosis of this disease.