title: Treatment strategies for central nervous system infections: an update.
abstract: BACKGROUND
  Central nervous system infection continues to be an important cause of mortality and morbidity worldwide. Our incomplete knowledge on the pathogenesis of how meningitis-causing pathogens cause CNS infection and emergence of antimicrobial resistance has contributed to the mortality and morbidity. An early empiric antibiotic treatment is critical for the management of patients with bacterial meningitis, but early recognition of bacterial meningitis continues to be a challenge.
  
  
  METHODS
  This review gives an overview on current therapeutic strategies for CNS infection with a focus on recent literature since 2010 on bacterial meningitis. Bacterial meningitis is a medical emergency, requiring early recognition and treatment. The selection of appropriate empiric antimicrobial regimen, after incorporating the epidemiology of bacterial meningitis, impact of vaccination, emergence of antimicrobial-resistant bacteria, role of adjunctive therapy and the current knowledge on the pathogenesis of meningitis and associated neuronal injury are covered.
  
  
  CONCLUSIONS
  Prompt treatment of bacterial meningitis with an appropriate antibiotic is essential. Optimal antimicrobial treatment of bacterial meningitis requires bactericidal agents able to penetrate the blood-brain barrier, with efficacy in cerebrospinal fluid. Emergence of CNS-infecting pathogens with resistance to conventional antibiotics has been increasingly recognized, but development of new antibiotics has been limited. More complete understanding of the microbial and host factors that are involved in the pathogenesis of bacterial meningitis and associated neurologic sequelae is likely to help in developing new strategies for the prevention and therapy of bacterial meningitis.
authors.affiliation: Johns Hopkins University School of Medicine, Division of Pediatric Infectious Diseases , 200 North Wolfe Street, Baltimore, MD 21287 , USA.
authors.forename: Ying Ching
authors.initials: YC
authors.lastname: Tan
authors.forename: Arshdeep Kaur
authors.initials: AK
authors.lastname: Gill
authors.forename: Kwang Sik
authors.initials: KS
authors.lastname: Kim
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001428:Bacterial Vaccines; D003072:Cognition Disorders / Q000139:chemically induced / Q000517:prevention & control; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D006193:Haemophilus influenzae; D034381:Hearing Loss / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D009345:Neisseria meningitidis; D009474:Neurons / Q000187:drug effects / Q000473:pathology; D013296:Streptococcus pneumoniae
chemical_list: D000900:Anti-Bacterial Agents; D001428:Bacterial Vaccines
keywords: Escherichia coli; Haemophilus influenzae type b; Listeria monocytogenes; Neisseria meningitidis; Streptococcus pneumoniae; antimicrobial resistance; antimicrobial therapy; bacterial meningitis; blood–brain barrier; cerebrospinal fluid; dexamethasone; group B streptococcus; neurologic sequelae