title: Bacterial meningitis: an update of new treatment options.
abstract: The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case-control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.
authors: a 1 Department of Geriatrics, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany.|b 2 Department of Neuropathology, Georg August University Göttingen, Göttingen, Germany.
authors: Roland
authors: R
authors: Nau
authors: a 1 Department of Geriatrics, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany.|b 2 Department of Neuropathology, Georg August University Göttingen, Göttingen, Germany.
authors: Marija
authors: M
authors: Djukic
authors: c 3 Department of Neurology, Georg August University Göttingen, Göttingen, Germany.
authors: Annette
authors: A
authors: Spreer
authors: b 2 Department of Neuropathology, Georg August University Göttingen, Göttingen, Germany.
authors: Sandra
authors: S
authors: Ribes
authors: d 4 Department of Medical Microbiology, Georg August University Göttingen, Göttingen, Germany.
authors: Helmut
authors: H
authors: Eiffert
mesh_terms: D000900:Anti-Bacterial Agents / Q000145:classification* / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy*; D019049:Developed Countries; D003907:Dexamethasone / Q000627:therapeutic use*; D006801:Humans; D016920:Meningitis, Bacterial / Q000188:drug therapy*; D014611:Vaccination; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D014815:Vitamins; D003907:Dexamethasone
keywords: Listeria monocytogenes; Neisseria meningitidis; Streptococcus pneumoniae; ampicillin; cefepime; ceftazidime; ceftriaxone; clindamycin; complement; daptomycin; eritoran; glycerol; hypothermia; immunotherapy; linezolid; monoclonal antibodies; n-acetylcysteine; palmitoylethanolamide; paracetamol; resveratrol; rifampicin; seliciclib; vancomycin