BACTERIAL-MENINGITIS IN CHILDREN AND ADULTS - CHANGES IN COMMUNITY-ACQUIRED DISEASE MAY AFFECT PATIENT-CARE

Despite improved understanding of how bacterial meningitis develops, t he infection remains a potentially life-threatening emergency capable of causing significant morbidity and mortality. Since the introduction and widespread use of H influenzae type b vaccine in infancy and chil dhood in North America, the epidemiology of community-acquired bacteri al meningitis has changed. S pneumoniae is now the most common cause i n children and adults overall, although N meningitidis causes most dis ease in patients between ages 2 and 18 years. Broad-spectrum cephalosp orins (eg, ceftriaxone, cefotaxime) are considered the agents of choic e for empirical treatment of bacterial meningitis. However, use of the se agents will have to be reconsidered if the incidence of invasive in fection from drug-resistant S pneumoniae continues to increase. The ro le of adjunctive corticosteroid therapy needs to be better defined. Im proved conjugate pneumococcal and meningococcal vaccines may soon make bacterial meningitis a preventable disease. PGM.