Johns Hopkins University School of Medicine, 200 North Wolfe Street, Room 3157, Baltimore, MD 21287, USA.
Expert Opin Pharmacother. 2012 Oct;13(15):2189-206. doi: 10.1517/14656566.2012.724399.
The introduction of protein conjugate vaccines for Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (S. pneumoniae) and Neisseria meningitidis (N. menigitidis) has changed the epidemiology of bacterial meningitis. Bacterial meningitis continues to be an important cause of mortality and morbidity, and our incomplete knowledge of its pathogenesis and emergence of antimicrobial resistant bacteria contribute to such mortality and morbidity. An early empiric antibiotic treatment is critical for the management of patients with bacterial meningitis.
This article gives an overview on optimal treatment strategies of bacterial meningitis, along with considerations of new insights on epidemiology, clinical and laboratory findings supportive of bacterial meningitis, chemoprophylaxis, selection of initial antimicrobial agents for suspected bacterial meningitis, antimicrobial resistance and utility of new antibiotics, status on anti-inflammatory agents and adjunctive therapy, and pathogenesis of bacterial meningitis.
Prompt treatment of bacterial meningitis with an appropriate antibiotic is essential. Optimal antimicrobial treatment of bacterial meningitis requires bactericidal agents able to penetrate the blood-brain barrier (BBB), with efficacy in cerebrospinal fluid (CSF). Several new antibiotics have been introduced for the treatment of meningitis caused by resistant bacteria, but their use in human studies has been limited. More complete understanding of the microbial and host interactions that are involved in the pathogenesis of bacterial meningitis and associated neurologic sequelae is likely to help in developing new strategies for the prevention and therapy of bacterial meningitis.
乙型流感嗜血杆菌（Hib）、肺炎链球菌（S. pneumoniae）和脑膜炎奈瑟菌（N. meningitidis）蛋白结合疫苗的引入改变了细菌性脑膜炎的流行病学。细菌性脑膜炎仍然是导致死亡率和发病率的重要原因，我们对其发病机制和抗菌药物耐药菌的出现认识不完全，导致了这种死亡率和发病率。早期经验性抗生素治疗对细菌性脑膜炎患者的治疗至关重要。
本文概述了细菌性脑膜炎的最佳治疗策略，并考虑了流行病学、支持细菌性脑膜炎的临床和实验室发现、化学预防、疑似细菌性脑膜炎初始抗菌药物的选择、抗菌药物耐药性和新型抗生素的应用、抗炎药物和辅助治疗的现状以及细菌性脑膜炎的发病机制方面的新见解。
细菌性脑膜炎的及时治疗至关重要。细菌性脑膜炎的最佳抗菌治疗需要能够穿透血脑屏障（BBB）并在脑脊液（CSF）中具有疗效的杀菌药物。已经引入了几种新型抗生素来治疗耐药菌引起的脑膜炎，但在人类研究中的应用有限。更全面地了解涉及细菌性脑膜炎发病机制和相关神经后遗症的微生物和宿主相互作用，可能有助于制定预防和治疗细菌性脑膜炎的新策略。
