Advances in treatment of bacterial meningitis
Bacterial meningitis kills or maims about a fifth of people with the disease. Early antibiotic treatment improves outcomes, but the effectiveness of widely available antibiotics is threatened by global emergence of multidrug-resistant bacteria. New antibiotics, such as fluoroquinolones, could have a...
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| Veröffentlicht in: | The Lancet (British edition) Jg. 380; H. 9854; S. 1693 - 1702 |
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| Hauptverfasser: | , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
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Kidlington
Elsevier Ltd
10.11.2012
Elsevier Elsevier Limited |
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| ISSN: | 0140-6736, 1474-547X, 1474-547X |
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| Abstract | Bacterial meningitis kills or maims about a fifth of people with the disease. Early antibiotic treatment improves outcomes, but the effectiveness of widely available antibiotics is threatened by global emergence of multidrug-resistant bacteria. New antibiotics, such as fluoroquinolones, could have a role in these circumstances, but clinical data to support this notion are scarce. Additionally, whether or not adjunctive anti-inflammatory therapies (eg, dexamethasone) improve outcomes in patients with bacterial meningitis remains controversial; in resource-poor regions, where the disease burden is highest, dexamethasone is ineffective. Other adjunctive therapeutic strategies, such as glycerol, paracetamol, and induction of hypothermia, are being tested further. Therefore, bacterial meningitis is a substantial and evolving therapeutic challenge. We review this challenge, with a focus on strategies to optimise antibiotic efficacy in view of increasingly drug-resistant bacteria, and discuss the role of current and future adjunctive therapies. |
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| AbstractList | Summary Bacterial meningitis kills or maims about a fifth of people with the disease. Early antibiotic treatment improves outcomes, but the effectiveness of widely available antibiotics is threatened by global emergence of multidrug-resistant bacteria. New antibiotics, such as fluoroquinolones, could have a role in these circumstances, but clinical data to support this notion are scarce. Additionally, whether or not adjunctive anti-inflammatory therapies (eg, dexamethasone) improve outcomes in patients with bacterial meningitis remains controversial; in resource-poor regions, where the disease burden is highest, dexamethasone is ineffective. Other adjunctive therapeutic strategies, such as glycerol, paracetamol, and induction of hypothermia, are being tested further. Therefore, bacterial meningitis is a substantial and evolving therapeutic challenge. We review this challenge, with a focus on strategies to optimise antibiotic efficacy in view of increasingly drug-resistant bacteria, and discuss the role of current and future adjunctive therapies. Bacterial meningitis kills or maims about a fifth of people with the disease. Early antibiotic treatment improves outcomes, but the effectiveness of widely available antibiotics is threatened by global emergence of multidrug-resistant bacteria. New antibiotics, such as fluoroquinolones, could have a role in these circumstances, but clinical data to support this notion are scarce. Additionally, whether or not adjunctive anti-inflammatory therapies (eg, dexamethasone) improve outcomes in patients with bacterial meningitis remains controversial; in resource-poor regions, where the disease burden is highest, dexamethasone is ineffective. Other adjunctive therapeutic strategies, such as glycerol, paracetamol, and induction of hypothermia, are being tested further. Therefore, bacterial meningitis is a substantial and evolving therapeutic challenge. We review this challenge, with a focus on strategies to optimise antibiotic efficacy in view of increasingly drug-resistant bacteria, and discuss the role of current and future adjunctive therapies. Bacterial meningitis kills or maims about a fifth of people with the disease. Early antibiotic treatment improves outcomes, but the effectiveness of widely available antibiotics is threatened by global emergence of multidrug-resistant bacteria. New antibiotics, such as fluoroquinolones, could have a role in these circumstances, but clinical data to support this notion are scarce. Additionally, whether or not adjunctive anti-inflammatory therapies (eg, dexamethasone) improve outcomes in patients with bacterial meningitis remains controversial; in resource-poor regions, where the disease burden is highest, dexamethasone is ineffective. Other adjunctive therapeutic strategies, such as glycerol, paracetamol, and induction of hypothermia, are being tested further. Therefore, bacterial meningitis is a substantial and evolving therapeutic challenge. We review this challenge, with a focus on strategies to optimise antibiotic efficacy in view of increasingly drug-resistant bacteria, and discuss the role of current and future adjunctive therapies.Bacterial meningitis kills or maims about a fifth of people with the disease. Early antibiotic treatment improves outcomes, but the effectiveness of widely available antibiotics is threatened by global emergence of multidrug-resistant bacteria. New antibiotics, such as fluoroquinolones, could have a role in these circumstances, but clinical data to support this notion are scarce. Additionally, whether or not adjunctive anti-inflammatory therapies (eg, dexamethasone) improve outcomes in patients with bacterial meningitis remains controversial; in resource-poor regions, where the disease burden is highest, dexamethasone is ineffective. Other adjunctive therapeutic strategies, such as glycerol, paracetamol, and induction of hypothermia, are being tested further. Therefore, bacterial meningitis is a substantial and evolving therapeutic challenge. We review this challenge, with a focus on strategies to optimise antibiotic efficacy in view of increasingly drug-resistant bacteria, and discuss the role of current and future adjunctive therapies. |
| Author | Tunkel, Allan R Thwaites, Guy E van de Beek, Diederik Brouwer, Matthijs C |
| Author_xml | – sequence: 1 givenname: Diederik surname: van de Beek fullname: van de Beek, Diederik email: d.vandebeek@amc.uva.nl organization: Department of Neurology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands – sequence: 2 givenname: Matthijs C surname: Brouwer fullname: Brouwer, Matthijs C organization: Department of Neurology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands – sequence: 3 givenname: Guy E surname: Thwaites fullname: Thwaites, Guy E organization: Department of Infectious Diseases/Centre for Clinical Infection and Diagnostics Research, Kings College London, London, UK – sequence: 4 givenname: Allan R surname: Tunkel fullname: Tunkel, Allan R organization: Department of Medicine, Monmouth Medical Center, Long Branch, NJ, USA |
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| Issue | 9854 |
| Keywords | Infection Medicine Bacteriosis Nervous system diseases Bacterial meningitis Treatment |
| Language | English |
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| Snippet | Bacterial meningitis kills or maims about a fifth of people with the disease. Early antibiotic treatment improves outcomes, but the effectiveness of widely... Summary Bacterial meningitis kills or maims about a fifth of people with the disease. Early antibiotic treatment improves outcomes, but the effectiveness of... |
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| SubjectTerms | acetaminophen Anti-Bacterial Agents - therapeutic use Antibiotics Bacteria Bacterial diseases Bacterial diseases of the nervous system. Bacterial myositis Biological and medical sciences burden of disease Community-Acquired Infections - drug therapy Community-Acquired Infections - epidemiology dexamethasone Disease Drug Therapy, Combination Epidemiology fluoroquinolones Forecasting General aspects Global Health glycerol Gram-Negative Bacterial Infections - drug therapy Gram-Positive Bacterial Infections - drug therapy Human bacterial diseases Humans Hypothermia Infectious diseases Internal Medicine Listeria Medical sciences Meningitis Meningitis, Bacterial - drug therapy Meningitis, Bacterial - epidemiology Mortality multiple drug resistance patients Penicillin Resistance people Recurrence Streptococcus infections Therapies, Investigational Treatment Outcome |
| Title | Advances in treatment of bacterial meningitis |
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