CAUSATIVE ORGANISMS, CLINICAL SYMPTOMS AN D THERAPY OF BACTERIAL CENTRAL-NERVOUS-SYSTEM INFECTIONS

Although bacterial meningitis is a notifiable disease, the epidemiolog y of bacterial CNS infections is only partly known in Germany. The fre quency of the causative pathogens isolated depends on the patients stu died. In adults with community-acquired meningitis or meningoencephali tis, pneumococci and meningococci are most frequent. On the contrary, staphylococci predominate in infections after neurosurgery, and strept ococci and staphylococci prevail in septic encephalitis. Meningococci and almost all pneumococci isolated from patients with CNS infections in Germany continue to be fully sensitive to penicillins. For empiric therapy of bacterial meningitis and encephalitis we prefer the combina tion of high dose ampicillin or amoxycillin in addition to an aminogly coside. In the presence of immunosuppression or other diseases predisp osing to infections with certain pathogens this combination is to be m odified or broadened. The combination of aminopenicillin and aminoglyc oside is active also against Listeria monocytogenes and enterococci. S ince cephalosporines do not cover these pathogens, they should not be recommended as single agents for empiric therapy in adults. For the tr eatment of CNS tuberculosis the combination of isoniazide, rifampicin plus pyrazinamide is most promising.