[Effect of glucocorticoids on benzylpenicillin penetration across the hemato-encephalic barrier and on the clinical course and outcome of meningococcal meningitis].

It was shown experimentally on rabbits and clinically in patients with meningococcal meningitis that glucocorticoids had no direct effect on penetration of penicillin through the hematoencephalic barrier. A decrease in the penicillin concentration in the liquor correlated with a decrease in the inflammation level of the meninges under the effect of a long-term (more than 3--4 days) corticosteroid therapy. As a result the penicillin concentration in the cerebrospinal fluid (0.09--0.4 units/ml) could not provide, in some cases, the bactericidal effect on the low sensitive meningococcal strains which induced protracted sanation of the liquor, slow progression of the diseases and worse outcomes. A short-term treatment with glucocorticoids (1--2 days) had a significant detoxifying effect without prolongation of the inflammation periods in the tissues of the central nervous system and did not make worse the disease outcomes according to the clinical and electroencephalographic data. When the use of glucocorticoids is required for a long period of time, it is advisable to increase the penicillin daily dose to 500 000 units per 1 kg of the body weight.