a 1 Department of Geriatrics, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany.
b 2 Department of Neuropathology, Georg August University Göttingen, Göttingen, Germany.
Expert Rev Anti Infect Ther. 2015;13(11):1401-23. doi: 10.1586/14787210.2015.1077700. Epub 2015 Aug 18.
The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case-control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.
细菌性脑膜炎的结局取决于是否能迅速开始杀菌性抗生素治疗和是否能充分控制感染性休克。在社区获得性脑膜炎中，最佳初始经验性抗生素方案的选择取决于地区耐药模式。在医院获得性细菌性脑膜炎中，对抗菌药物耐药的病原体占主导地位。地塞米松被推荐作为发达国家社区获得性脑膜炎的辅助治疗药物。在昏迷患者中，一项病例对照研究显示，积极降低颅内压<20mmHg（特别是外部脑室引流、渗透压治疗和短暂过度通气）的措施是有效的。尽管许多实验方法在动物模型中具有保护作用，但在患者中没有一种方法被证明是有效的。杀菌但不裂解细菌的抗生素以及基质金属蛋白酶或补体因子 C5 的抑制剂似乎是最有前途的治疗选择。目前，疫苗接种是降低疾病负担的最有效方法。棕榈酸乙醇酰胺似乎有望增强大脑对感染的抵抗力。
