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Treatment of bacterial meningitis caused by specific pathogens in adults

Author
Allan R Tunkel, MD, PhD, MACP
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Anna R Thorner, MD

INTRODUCTION

Bacterial meningitis is a medical emergency, and immediate steps must be taken to establish the specific cause and initiate effective therapy. The mortality rate of untreated disease approaches 100 percent and, even with optimal therapy, there is a high failure rate.

The possible presence of bacterial meningitis is suggested by the symptoms of fever, altered mental status, headache, and nuchal rigidity. Although one or more of these findings are absent in many patients with bacterial meningitis [1-4], virtually all patients (99 to 100 percent) have at least one of the classic triad of fever, neck stiffness, and altered mental status [4]. (See "Clinical features and diagnosis of acute bacterial meningitis in adults".)

The treatment and prevention of bacterial meningitis caused by specific pathogens will be reviewed here. The epidemiology, pathogenesis, clinical features, diagnosis, initial management, and use of dexamethasone for the treatment of bacterial meningitis are discussed separately. (See "Epidemiology of bacterial meningitis in adults" and "Pathogenesis and pathophysiology of bacterial meningitis" and "Clinical features and diagnosis of acute bacterial meningitis in adults" and "Initial therapy and prognosis of bacterial meningitis in adults" and "Dexamethasone to prevent neurologic complications of bacterial meningitis in adults".)

APPROACH TO THERAPY

There are a number of general principles of antimicrobial therapy in patients with bacterial meningitis. The most important initial issues are avoidance of delay in administering therapy and the choice of drug regimen. (See "Initial therapy and prognosis of bacterial meningitis in adults", section on 'General principles of therapy'.)

Empiric therapy — Antimicrobial therapy, along with adjunctive dexamethasone when indicated, should be initiated immediately after the performance of the lumbar puncture (LP) or, if a computed tomography (CT) scan of the head is to be performed before LP, immediately after blood cultures are obtained. Adjunctive dexamethasone should be given shortly before or at the same time as the first dose of antimicrobials, when indicated. (See "Initial therapy and prognosis of bacterial meningitis in adults", section on 'Avoidance of delay'.)

                            

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Literature review current through: Nov 2016. | This topic last updated: Thu Jul 07 00:00:00 GMT+00:00 2016.
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