BACTERIAL-MENINGITIS - NON-ANTIBIOTIC MODES OF THERAPY

Bacterial meningitis remains common and devastating; despite recent advances in antimicrobial therapy, the overall morbidity and mortality remains high. Recent advances in the understanding of the pathogenesis and pathophysiology of bacterial meningitis have led to the development of innovative treatment strategies in the hopes of improving outcome from this disorder. Studies in animal models have demonstrated that attenuation of the subarachnoid space inflammatory response by anti-inflammatory agents may be useful in preventing many of the pathophysiologic consequences of bacterial meningitis such as cerebral edema and increased intracranial pressure. In addition, several recent clinical trials have shown that the anti-inflammatory agent dexamethasone is beneficial in certain patients with bacterial meningitis. Administration of adjunctive dexamethasone, in conjunction with antimicrobial agents, is recommended for infants and children with Haemophilus influenzae type b meningitis. Pending the results of ongoing studies, adjunctive dexamethasone is not recommended in adults, in infants less than 2 months old, or in patients with meningitis caused by bacteria other than H. influenzae. Other agents that reduce subarachnoid space inflammation, specifically monoclonal antibodies directed against the CD18 family of leukocyte receptors, may also prove to be beneficial in improving outcome in patients with bacterial meningitis.