Issues in the management of bacterial meningitis have focused on pneum
ococcal infection. Cell walls appear to induce inflammation differentl
y from endotoxins. Adjunctive therapeutics, including carbohydrates, p
eptides, and antibodies, target vascular abnormalities as well as leuk
ocyte adhesion. New therapeutic recommendations suggest no fluid restr
iction and invoke caution when combining dexamethasone with vancomycin
for highly beta-lactam-resistant pneumococcal disease.