ISSUES IN THE MANAGEMENT OF BACTERIAL-MENINGITIS

Acute bacterial meningitis is associated with significant morbidity an d mortality despite the availability of effective antimicrobial therap y. The emergence of antibiotic-resistant bacterial strains in recent y ears has necessitated the development of new strategies for empiric an timicrobial therapy for bacterial meningitis. Specifically, the emerge nce of strains of Streptococcus pneumoniae that are resistant to penic illin and the cephalosporins have led to empiric therapy for patients with pneumococcal meningitis consisting of vancomycin plus a third-gen eration cephalosporin pending susceptibility testing. Third-generation cephalosporins are also effective as empiric therapy against other pa thogens that cause community-acquired bacterial meningitis, with the e xception of Listeria monocytogenes, for which ampicillin or penicillin G is the antimicrobial agent of choice. Adjunctive dexamethasone shou ld be administered to infants and children with suspected or proven Ha emophilus influenzae type b meningitis to reduce audiologic and neurol ogic sequelae; administration concomitant with or just before the firs t dose of the antimicrobial agent is optimal for best results.