Treatment of Bacterial Meningitis

Quagliarello, Vincent; Scheld, W. Michael

doi:10.1056/nejm199703063361007

Cited by 432 publications

(199 citation statements)

References 89 publications

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“…We did not identify specific factors associated with tardy treatment. Other studies found that unnecessary diagnostic procedures could also result in late diagnosis and treatment of patients with bacterial meningitis (5,21,22).…”

Section: Discussionmentioning

confidence: 99%

“…Except for proved benefit from adjunctive corticosteroid treatment, particularly in pneumococcal disease, there are no significant improvements in diagnostic and therapeutic approach to adult patients with bacterial meningitis (1)(2)(3)(4). The overall mortality rate before the routine use of dexamethasone was high, up to 28%, in pneumococcal meningitis even up to 37% (4)(5)(6)(7)(8)(9)(10)(11). A large number of survivors suffer from long-term neurological sequelae (4).…”

Section: Introductionmentioning

confidence: 99%

“…It is reasonable to believe that treatment outcome could be improved by timely and appropriate antibiotic therapy. Various recent studies have tried to assess the role of antibiotic timing in disease outcome, but final evidence is still lacking (5,12).…”

Section: Introductionmentioning

confidence: 99%

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Community-Acquired Bacterial Meningitis in Adults: Antibiotic Timing in Disease Course and Outcome

Lepur

Baršić

2007

Infection

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Word count of the abstract: 296 Word count of the text: 2695Key words: bacterial meningitis, adults, risk factors, antibiotic timing, clinical outcome Conflict of interestNone. Authors' contributionsBoth authors planned, wrote, reviewed and revised the article and approved the final version of the manuscript. Dr Lepur was primarily responsible for data collection and basic statistics. Prof Baršić performed advanced statistical tests. 2 ABSTRACT ObjectivesDespite improvements in diagnostic and therapeutic approach to adult patients with bacterial meningitis, the overall mortality rate is still high. The aim of this study was to evaluate antibiotic timing in the course and outcome of bacterial meningitis.. MethodsTwo hundred and eighty six patients with community-acquired bacterial meningitis aged 14 years and more were included in this retrospective cohort study. Observational period was between 1 January 1990 and 31 December 2004. To assess the association of antibiotic timing and disease outcome we analyzed three timing periods (according to the onset of disease, onset of consciousness disturbance and the time of admission to hospital). Analysis was also performed in a subgroup of culture positive meningitis in 176 patients with altered mental status. ResultsUnfavorable outcome was found in 125 (43,7%) patients. In this group, the start of appropriate antibiotic treatment in relation to the onset of first symptoms and particularly to the onset of consciousness disturbance was significantly delayed (p=0,018 and p<0,001 respectively) compared to the favorable group. Logistic regression analysis in a subgroup of culture positive meningitis in patients with altered mental status revealed that early adequate antibiotic treatment related to the onset of overt signs of meningitis was independently associated with favorable outcome (OR= 11,19; 95% CI 4,57; p<0,001). Advanced age, lower GCS and seizures (OR=1.05,OR=1,45 and OR= 3.65, respectively ) were other risk factors of poor outcome. The presence of chronic diseases, pneumococcal etiology and clinical and laboratory variables which are indicators of disease severity (renal and/or liver 3 dysfunction, hypotension and low cerebrospinal fluid glucose) were not confirmed as independent risk factors of poor outcome. ConclusionsOur study emphasizes the importance of early and adequate antibiotic treatment in the management of bacterial meningitis which significantly enhances the chances for favorable outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Community-Acquired Bacterial Meningitis in Adults: Antibiotic Timing in Disease Course and Outcome

Lepur

Baršić

2007

Infection

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“…After the first month of life, bacteria responsible for 70%-90% of cases of acute bacterial meningitis in most regions of the world are N. meningitidis and S. pneumoniae (5,6). The incidence of infection by H. influenzae showed significant decline following systematic vaccination.…”

Section: Introductionmentioning

confidence: 99%

Quantitation of cerebrospinal fluid lactic acid in infectious and non-infectious neurological diseases

Almeida

Faria

Fontes

et al. 2009

Clinical Chemistry and Laboratory Medicine

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Background: The differential diagnosis between bacterial and viral meningitis is not easy in some cases. Cerebrospinal fluid (CSF) analysis is essential for establishing this diagnosis. The objectives were to quantitate lactic acid (LA) concentrations in bacterial and viral meningitis, and other central nervous system (CNS) diseases in order to evaluate the diagnostic utility of CSF LA for discriminating bacterial from viral meningitis. Methods: CSF LA was measured in 139 CSF samples from seven groups: viral meningitis with classic CSF; suspicion of viral meningitis with neutrophils in CSF; bacterial meningitis; non-infectious neurological diseases; chronic meningitis; traumatic lumbar puncture (LP) and normal CSF. Results: CSF LA was higher in bacterial meningitis 8.7q5.4 mmol/L compared with viral meningitis (1.9q0.6) and the other groups (p-0.0001). CSF LA in the groups with viral meningitis was not different compared to groups with non-infectious CNS diseases and chronic meningitis. The ability of CSF LA to discriminate bacterial from viral meningitis showed a sensitivity of 80% and specificity of 97%, positive predictive value (PPV) of 94%, and negative predictive value (NPV) of 89%. Conclusions: CSF LA is a powerful test to discriminate bacterial from viral meningitis with high sensitivity,

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“…Ampicillin has proved clinically effective against a variety of brain infections, including bacterial meningitis and brain abscesses (Kanra, 2002). High doses of ampicillin (12 g/day for adults) are effective in the treatment of bacterial meningitis (Quagliarello & Scheld, 1997). An ampicillin dose of 200 mg/kg in a 20 g mouse (as given pre-ischemically in the present study), which provided neuroprotection against ischemic insult, can be regarded as equivalent to a dose of 1.2 g in a 70 kg human, according to the interspecies scaling relationship: Dhuman=Danimal (Whuman/Wanimal) 0.7 , where D denotes the dose of ampicillin in milligrams and W denotes weight in kilograms (Mordenti & Chappell, 1989).…”

Section: Discussionmentioning

confidence: 99%

Pre-ischemic Treatment with Ampicillin Reduces Neuronal Damage in the Mouse Hippocampus and Neostriatum after Transient Forebrain Ischemia

Lee

Kim

Cho

et al. 2008

Korean J Physiol Pharmacol

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Ampicillin, a β -lactam antibiotic, has been reported to induce astrocytic glutamate transporter-1 which plays a crucial role in protecting neurons against glutamate excitotoxicity. W e investigated the effect of ampicillin on neuronal damage in the mouse hippocampus and neostriatum following transient global forebrain ischemia. Male C57BL/6 mice were anesthetized with halothane and subjected to bilateral occlusion of the common carotid artery for 40 min. Ampicillin was administered post-ischemically (for 3 days) and/or pre-ischemically (for 3∼ 5 days until one day before the onset of ischemia). Pre-and post-ischemic treatment with ampicillin (50 mg/kg/day or 200 mg/kg/day) prevented ischemic neuronal death in the medial CA1 area of the hippocampus as well as the neostriatum in a dose-dependent manner. In addition, ischemic neuronal damage was reduced by pre-ischemic treatment with ampicillin (200 mg/kg/day). In summary, our results suggest that ampicillin plays a functional role as a chemical preconditioning agent that protects hippocampal neurons from ischemic insult.

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Treatment of Bacterial Meningitis

Cited by 432 publications

References 89 publications

Community-Acquired Bacterial Meningitis in Adults: Antibiotic Timing in Disease Course and Outcome

Community-Acquired Bacterial Meningitis in Adults: Antibiotic Timing in Disease Course and Outcome

Quantitation of cerebrospinal fluid lactic acid in infectious and non-infectious neurological diseases

Pre-ischemic Treatment with Ampicillin Reduces Neuronal Damage in the Mouse Hippocampus and Neostriatum after Transient Forebrain Ischemia

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