[Treatment of community acquired bacterial meningitis, after microbiological identification].
BACKGROUND
Are the 1996 SPILF consensus conference recommendations on bacterial meningitis (BM) still adequate?


OBJECTIVE
The literature published after 1996 was analyzed and the reviewers summarized the available data on antibiotic treatment once BM microbiological diagnosis made or strongly suspected.


METHODS
A review was made using PubMed, 10,015 references were examined. Only articles published after 1997 were analyzed.


RESULTS
No study allowed to recommend other regimens than those previously recommended in 1996, in case of meningococcal or pneumococcal infection: 3rd generation cephalosporin or amoxicillin, combined with vancomycin in case of penicillin-intermediate or resistant pneumococcus. In some cases, alternatives are possible, in case of pneumococcal infection: meropenem or antipneumococcal fluoroquinolone were recommended by US guidelines. New antibiotics available on the market were tested using experimental pneumococcal meningitis models: daptomycin and ertapenem seemed to be useful but linezolid was not. Among the antibiotic combinations tested, ceftriaxone+rifampicine demonstrated a better efficacy than ceftriaxone+vancomycin. There was not contributive published data on the length of treatment for bacterial meningitis.


CONCLUSIONS
No assessed arguments could be found to modify previous guidelines. In case of problem with penicillin-resistant pneumococci, penem or a combination using ceftriaxone and rifampicin may be used.
Stahl
J-P
JP
Service des maladies infectieuses et tropicales, CHU et université Joseph-Fourier, 38043 Grenoble, France. JPStahl@chu-grenoble.fr
D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000382:microbiology; D003226:Congresses as Topic; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D006801:Humans; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000635:transmission; D008589:Meningococcal Infections / Q000188:drug therapy; D011008:Pneumococcal Infections / Q000188:drug therapy; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D014640:Vancomycin; D000658:Amoxicillin