BACTERIAL-MENINGITIS - NON-ANTIBIOTIC MODES OF THERAPY

Bacterial meningitis remains common and devastating; despite recent ad vances in antimicrobial therapy, the overall morbidity and mortality r emains high. Recent advances in the understanding of the pathogenesis and pathophysiology of bacterial meningitis have led to the developmen t of innovative treatment strategies in the hopes of improving outcome from this disorder. Studies in animal models have demonstrated that a ttenuation of the subarachnoid space inflammatory response by anti-inf lammatory agents may be useful in preventing many of the pathophysiolo gic consequences of bacterial meningitis such as cerebral edema and in creased intracranial pressure. In addition, several recent clinical tr ials have shown that the anti-inflammatory agent dexamethasone is bene ficial in certain patients with bacterial meningitis. Administration o f adjunctive dexamethasone, in conjunction with antimicrobial agents, is recommended for infants and children with Haemophilus influenzae ty pe b meningitis. Pending the results of ongoing studies, adjunctive de xamethasone is not recommended in adults, in infants less than 2 month s old, or in patients with meningitis caused by bacteria other than H. influenzae. Other agents that reduce subarachnoid space inflammation, specifically monoclonal antibodies directed against the CD18 family o f leukocyte receptors, may also prove to be beneficial in improving ou tcome in patients with bacterial meningitis.