Antimicrobial treatment and prevention of meningitis.

The efficacy of the conjugate polysaccharide H influenzae type b vaccine has resulted in a reduction in the number of cases of meningitis. Physicians will manage fewer cases of meningitis but they must maintain skills in diagnosis and treatment of the cases that do occur. In addition, to a continuing experience with meningitis due to S pneumoniae and N meningitidis, physicians must be aggressive in obtaining materials for specific diagnosis of aseptic meningitis since many of the infections are treatable with antimicrobial agents. Appropriate treatment of meningitis in children requires knowledge of agents for initial therapy, dosage schedules, changes in the regimen that may be required once the organism is isolated and results of susceptibility tests are available, knowledge of the drugs that require monitoring of serum concentrations to determine safety and efficacy, and antimicrobial prophylaxis for contacts.