title: Update on bacterial meningitis: epidemiology, trials and genetic association studies.
abstract: OBJECTIVE
  Bacterial meningitis is a life-threatening disease that continues to inflict a heavy toll. We reviewed recent advances in vaccination, randomized studies on treatment, and genetic association studies in bacterial meningitis.
  
  
  RESULTS
  The incidence of bacterial meningitis has decreased after implementation of vaccines, and further implementation of existing conjugate vaccines particularly in low-income countries is expected to reduce the global disease burden. Several randomized studies have been performed recently in this field. Clinical studies showed that short duration (5 days) of antibiotic treatment is as effective as longer duration treatment in low-income countries, and that dexamethasone decreases death and neurological sequelae in high-income countries. Ongoing trials will further define the role of paracetamol, glycerol and hypothermia in bacterial meningitis. Genetic association studies identified pathophysiological mechanisms that could be counteracted in experimental meningitis, providing promising leads for future treatments.
  
  
  CONCLUSIONS
  Conjugate vaccines have reduced the burden of bacterial meningitis in high-income countries, but implementation of available vaccines in low-income countries is necessary to reduce disease burden worldwide. Adjunctive dexamethasone therapy has beneficial effects in patients with bacterial meningitis but only in high-income countries. Genetic association studies may reveal targets for new treatment strategies.
authors.affiliation: Department of Neurology, Center of Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: E Soemirien
authors.initials: ES
authors.lastname: Kasanmoentalib
authors.forename: Matthijs C
authors.initials: MC
authors.lastname: Brouwer
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D056726:Genetic Association Studies; D006801:Humans; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D014611:Vaccination; D018074:Vaccines, Conjugate / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D018074:Vaccines, Conjugate