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The Lancet. Advances in treatment of bacterial meningitis
[Source: The Lancet, full text: (LINK). Abstract, edited.]
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The Lancet, Volume 380, Issue 9854, Pages 1693 - 1702, 10 November 2012
doi:10.1016/S0140-6736(12)61186-6
This article can be found in the following collections: Infectious Diseases (Anti-infective therapy, Neurological infections, Paediatric infections); Neurology (Neurological infections); Paediatrics (Paediatric infections)
Advances in treatment of bacterial meningitis
Original Text
Prof Diederik van de Beek MD a, Matthijs C Brouwer MD a, Guy E Thwaites MD b c, Prof Allan R Tunkel MD d
Summary
Bacterial meningitis kills or maims about a fifth of people with the disease. Early antibiotic treatment improves outcomes, but the effectiveness of widely available antibiotics is threatened by global emergence of multidrug-resistant bacteria. New antibiotics, such as fluoroquinolones, could have a role in these circumstances, but clinical data to support this notion are scarce. Additionally, whether or not adjunctive anti-inflammatory therapies (eg, dexamethasone) improve outcomes in patients with bacterial meningitis remains controversial; in resource-poor regions, where the disease burden is highest, dexamethasone is ineffective. Other adjunctive therapeutic strategies, such as glycerol, paracetamol, and induction of hypothermia, are being tested further. Therefore, bacterial meningitis is a substantial and evolving therapeutic challenge. We review this challenge, with a focus on strategies to optimise antibiotic efficacy in view of increasingly drug-resistant bacteria, and discuss the role of current and future adjunctive therapies.
a Department of Neurology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; b Department of Infectious Diseases/Centre for Clinical Infection and Diagnostics Research, Kings College London, London, UK; c Guy's and St Thomas' NHS Foundation Trust, London, UK; d Department of Medicine, Monmouth Medical Center, Long Branch, NJ, USA
Correspondence to Prof Diederik van de Beek, Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, PO Box 22660, 1100DD Amsterdam, Netherlands
-doi:10.1016/S0140-6736(12)61186-6
This article can be found in the following collections: Infectious Diseases (Anti-infective therapy, Neurological infections, Paediatric infections); Neurology (Neurological infections); Paediatrics (Paediatric infections)
Advances in treatment of bacterial meningitis
Original Text
Prof Diederik van de Beek MD a, Matthijs C Brouwer MD a, Guy E Thwaites MD b c, Prof Allan R Tunkel MD d
Summary
Bacterial meningitis kills or maims about a fifth of people with the disease. Early antibiotic treatment improves outcomes, but the effectiveness of widely available antibiotics is threatened by global emergence of multidrug-resistant bacteria. New antibiotics, such as fluoroquinolones, could have a role in these circumstances, but clinical data to support this notion are scarce. Additionally, whether or not adjunctive anti-inflammatory therapies (eg, dexamethasone) improve outcomes in patients with bacterial meningitis remains controversial; in resource-poor regions, where the disease burden is highest, dexamethasone is ineffective. Other adjunctive therapeutic strategies, such as glycerol, paracetamol, and induction of hypothermia, are being tested further. Therefore, bacterial meningitis is a substantial and evolving therapeutic challenge. We review this challenge, with a focus on strategies to optimise antibiotic efficacy in view of increasingly drug-resistant bacteria, and discuss the role of current and future adjunctive therapies.
a Department of Neurology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; b Department of Infectious Diseases/Centre for Clinical Infection and Diagnostics Research, Kings College London, London, UK; c Guy's and St Thomas' NHS Foundation Trust, London, UK; d Department of Medicine, Monmouth Medical Center, Long Branch, NJ, USA
Correspondence to Prof Diederik van de Beek, Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, PO Box 22660, 1100DD Amsterdam, Netherlands
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