Bacterial meningitis: an update of new treatment options

Abstract

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.

Rational Design and Evaluation of an Artificial Escherichia coli K1 Protein Vaccine Candidate Based on the Structure of OmpA

“…After penetration into the blood circulation, where it multiplies, E. coli K1 invades human brain microvascular endothelial cells (HBMECs) and causes damage to brain tissues (Xie et al, 2004 ). Despite the conventional application of antibiotics and supportive care, the morbidity, and mortality rates of E. coli K1-associated neonatal meningitis remain unchanged (Nau et al, 2015 ; van de Beek et al, 2016 ). The fatality rates of E. coli K1-infected infants range from 5 to 30%, and the survivors often exhibit life-time sequelae, such as mental retardation, cortical blindness, and hearing loss (Croxen and Finlay, 2010 ; van de Beek et al, 2010 ).…”

Bacterial meningitis in Finland, 1995–2014: a population-based observational study

“… 7 However, the leading organisms causing bacterial meningitis vary by age of the patient, time and geographical location. 5 As the choice of empirical antimicrobial treatment for bacterial meningitis should be based on local epidemiology, patient’s age, presence of risk factors and regional resistance patterns, 8–10 population-based surveillance data are important to help in formulating clinical guidelines.…”

Prophylactic Palmitoylethanolamide Prolongs Survival and Decreases Detrimental Inflammation in Aged Mice With Bacterial Meningitis

“…The present study was performed in aged mice, which develop higher bacterial concentrations and a higher mortality compared to young adult mice after intracerebral infection with equal amounts of E. coli K1 ( 19 ). Because systemic complications are the leading cause of death in elderly patients with bacterial meningitis ( 7 ), reducing pathogen spread in the systemic circulation has the potential to broaden the therapeutic window, whereby the initiation of antibiotic therapies can rescue the patient, thus potentially improving survival of these patients in a clinical setting ( 11 ).…”

“…When LP is delayed for any reason, antibiotics shall be administered prior to LP ( 10 ). When antibiotic therapy is started after the point of no return, the patient will die irrespective of the therapy chosen ( 11 ). Accordingly, new avenues to prevent the emergence of infections and to extend the therapeutic window for potential antibiotic therapy in the elderly population are required.…”