Drug Insight: adjunctive therapies in adults with bacterial meningitis.
Despite the availability of effective antibiotics, mortality and morbidity rates associated with bacterial meningitis are high. Studies in animals have shown that bacterial lysis, induced by treatment with antibiotics, leads to inflammation in the subarachnoid space, which might contribute to an unfavorable outcome. The management of adults with bacterial meningitis can be complex, and common complications include meningoencephalitis, systemic compromise, stroke and raised intracranial pressure. Various adjunctive therapies have been described to improve outcome in such patients, including anti-inflammatory agents, anticoagulant therapies, and strategies to reduce intracranial pressure. Although a recent randomized trial provided evidence in favor of dexamethasone treatment, few randomized clinical studies are available for other adjunctive therapies in adults with bacterial meningitis. This review briefly summarizes the pathogenesis and pathophysiology of bacterial meningitis, and focuses on the evidence for and against use of the available adjunctive therapies in clinical practice.
van de Beek
Diederik
D
Academic Medical Center, Center of Infection and Immunity Amsterdam, University of Amsterdam, The Netherlands. d.vandebeek@amc.uva.nl
Weisfelt
Martijn
M
de Gans
Jan
J
Tunkel
Allan R
AR
Wijdicks
Eelco F M
EF
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002557:Cerebrospinal Fluid Shunts; D003131:Combined Modality Therapy; D004234:Diuretics, Osmotic / Q000627:therapeutic use; D005440:Fluid Therapy; D006401:Hematologic Agents / Q000627:therapeutic use; D006801:Humans; D007036:Hypothermia, Induced; D016920:Meningitis, Bacterial / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D004234:Diuretics, Osmotic; D006401:Hematologic Agents