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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.

Original publication

DOI

10.1016/S0140-6736(12)61186-6

Type

Journal article

Journal

Lancet

Publication Date

10/11/2012

Volume

380

Pages

1693 - 1702

Keywords

Anti-Bacterial Agents, Community-Acquired Infections, Drug Therapy, Combination, Forecasting, Global Health, Gram-Negative Bacterial Infections, Gram-Positive Bacterial Infections, Humans, Meningitis, Bacterial, Penicillin Resistance, Recurrence, Therapies, Investigational, Treatment Outcome