Initiate appropriate antibacterial and adjunctive therapies when treating bacterial meningitis
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Initiate appropriate antibacterial and adjunctive therapies when treating bacterial meningitis The epidemiology of bacterial meningitis has changed with the introduction of effective vaccines against its most common pathogens. However, bacterial meningitis remains an important cause of morbidity and mortality. Its management involves prompt empirical antibacterial therapy, followed by targeted antibacterial treatment once the infecting organism has been identified. Adjunctive dexamethasone may be indicated in some patients.
An important public health concern Meningitis is defined as inflammation of the lining of the brain and spinal cord and is characterized by an increased white blood cell count in the cerebrospinal fluid (CSF) that may be a result of infection, non-infectious agents or other aetiology.[1] Patients classically present with symptoms that may include fever, headache, neck stiffness and altered mental status, and a proportion of patients may also experience seizures.[1] With disease progression, there may also be signs of increased intracranial pressure, such as
coma, cranial nerve III palsy, bradycardia and hypertension. Some patients with certain types of meningitis (pneumococcal or meningococcal) may show few neurological signs but, rather, present with rapidly overwhelming sepsis.[1] The main diagnostic tool in defining bacterial meningitis is CSF examination by lumbar puncture.[1,2] Typically, patients with bacterial meningitis will have elevated opening pressure, high white blood cell count, and high protein and decreased glucose levels. Bacterial meningitis is associated with high rates of death and neurological sequelae (such as hearing loss) and its expeditious diagnosis and treatment are vital. This article briefly discusses the current approaches to the management of bacterial meningitis, as reviewed by Nudelman and Tunkel.[1]
Vaccination has dramatic effect The pathogens Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae have historically
Table 1. Summary of the treatment of bacterial meningitis caused by Listeria monocytogenes and Streptococcus agalactiae, as reviewed by Nudelman and Tunkel.[1] Choice of a specific agent must be guided by the susceptibility of the isolates and local guidelines Recommended specific antibacterials[2] standard alternative
General comments L. monocytogenes meningitis Accounts for 8% of bacterial meningitis cases in the US Associated mortality rate: 15–29% Most common in infants aged 60 y, pts with alcoholism, cancer or immunosuppression, and pts receiving corticosteroid therapy Other underlying predisposing conditions include diabetes mellitus, hepatic and chronic kidney disease, collagen-vascular disease and iron-overload states Adults aged 98% of cases of invasive disease are sporadic
Penicillin MIC
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