Major Research Findings

Acute bacterial meningitis remains a disease with high mortality and morbidity rates. However, with prompt and adequate antimicrobial and supportive treatment, the chances for survival have improved, especially in infants and children. 5 , 9 , 7 , 8 Careful management of fluid and electrolyte balance is an important supportive therapy. Both over- and under-hydration are associated with adverse outcomes. 5 , 9 , 7 , 8

Third-generation cephalosporins are recommended for the treatment of bacterial meningitis. However, these drugs are often not available in hospitals in low-income countries. 6

The use of corticosteroids as adjuvant therapy in the treatment of acute bacterial meningitis is controversial despite several controlled clinical trials and three meta-analyses. 3

Early treatment with dexamethasone has been shown to improve outcomes in adults with acute bacterial meningitis and does not increase the risk of gastrointestinal bleeding. 2

One hundred and one cases of purulent meningitis without any sign of immediate severity have been prospectively treated. Cefotaxime was given until the results of bacteriological tests; when possible, a randomisation separated one group in which cefotaxime was continued and another group in which cefotaxime was replaced by ampicillin. IV treatment was stopped at the 10th day even in cases with persisting fever. All patients less than or equal to 2 years of age were given phenobarbitone. Serious complications consisted of 4 cases of hypoacousia, equally distributed in either therapeutic group of Haemophilus meningitis. No child developed convulsions when receiving phenobarbitone. 1

Treatment Summary

Treatment for acute bacterial meningitis involves prompt administration of antibiotics and supportive care. 5 , 9 , 7 , 8 This is particularly important in infants and children, where it has significantly improved survival rates. 5 , 9 , 7 , 8 Third-generation cephalosporins are recommended, but if unavailable, a combination of ampicillin and chloramphenicol may be effective. 4 , 6 Corticosteroids may be used to reduce the severity of meningitis symptoms and the risk of neurological sequelae. 3 , 2 In particular, dexamethasone has been shown to improve outcomes in adults. 2 Phenobarbital is effective in preventing seizures in children. 1 Managing fluid and electrolyte balance is also important. 5 , 9 , 7 , 8

Benefits and Risks

Benefit Summary

Prompt and adequate antimicrobial and supportive treatment has improved survival rates, especially in infants and children. 5 , 9 , 7 , 8 Early treatment with dexamethasone has been shown to improve outcomes in adults with acute bacterial meningitis. 2 Phenobarbital is effective in preventing seizures in children. 1

Risk Summary

Both over- and under-hydration are associated with adverse outcomes. 5 , 9 , 7 , 8 Corticosteroids can have side effects such as peptic ulcer disease and immunosuppression. 3 , 2

Comparison Between Studies

Commonalities Between Studies

Most studies show that prompt administration of antibiotics and supportive care is crucial for the treatment of bacterial meningitis. 5 , 9 , 7 , 8 Additionally, managing fluid and electrolyte balance is important. 5 , 9 , 7 , 8

Differences Between Studies

Regarding antibiotics, third-generation cephalosporins are recommended, but if unavailable, a combination of ampicillin and chloramphenicol may be effective. 4 , 6 The use of corticosteroids is still controversial, despite several controlled clinical trials and meta-analyses. 3 In adults, dexamethasone has been shown to be effective. 2 In children, phenobarbital is effective in preventing seizures. 1

Consistency and Contradictions in Results

Many studies show that prompt administration of antibiotics and supportive care is effective for the treatment of bacterial meningitis. 5 , 9 , 7 , 8 However, the use of corticosteroids remains controversial, and further research is needed. 3 , 2

Real-World Application and Precautions

If you experience symptoms of bacterial meningitis, seek medical attention immediately. 5 , 9 , 7 , 8 Early treatment can significantly reduce mortality and morbidity rates. 5 , 9 , 7 , 8 Managing fluid and electrolyte balance is important. 5 , 9 , 7 , 8

Current Research Limitations

There is still insufficient research on the treatment of bacterial meningitis. 5 , 9 , 7 , 8 In particular, research on the use of corticosteroids remains controversial. 3 , 2

Future Research Directions

Further research is needed on the treatment of bacterial meningitis. 5 , 9 , 7 , 8 In particular, research on the use of corticosteroids should be strengthened. 3 , 2

Conclusion

Bacterial meningitis is a disease with high mortality and morbidity rates, but prompt and appropriate treatment can improve survival rates. 5 , 9 , 7 , 8 It is important to seek medical attention immediately if you experience symptoms of bacterial meningitis. 5 , 9 , 7 , 8

Treatment List

Antibiotics: Third-generation cephalosporins, ampicillin, chloramphenicol 4 , 6 Supportive care: Fluid administration, electrolyte management 5 , 9 , 7 , 8 Corticosteroids: Dexamethasone 3 , 2 Seizure prevention: Phenobarbital 1