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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Bibliographic Details
Published in:The Lancet (British edition) Vol. 380; no. 9854; pp. 1693 - 1702
Main Authors: van de Beek, Diederik, Brouwer, Matthijs C, Thwaites, Guy E, Tunkel, Allan R
Format: Journal Article
Language:English
Published: Kidlington Elsevier Ltd 10.11.2012
Elsevier
Elsevier Limited
Subjects:
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
Infection
Medicine
Bacteriosis
Nervous system diseases
Bacterial meningitis
Treatment
ISSN:0140-6736, 1474-547X, 1474-547X
Online Access:Get full text
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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.
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ISSN:0140-6736
1474-547X
1474-547X
DOI:10.1016/S0140-6736(12)61186-6