Monday, October 3, 2016

Adjunctive Therapies in Bacterial Meningitis

 ICM Cases - October 2, 2016
"What adjunctive therapies, if any, are effective in the treatment of bacterial meningitis?
Sequential meta-analyses have attempted to resolve the uncertainty. These have variously included adults and/or children, in the developed and/or developing world. The most recent and largest of these is the 2013 Cochrane meta-analysis of 4121 patients in 25 randomised trials...
Lessons learnt
Patients presenting with symptoms suggestive of bacterial meningitis must be treated promptly with appropriate CSF-penetrating bactericidal antibiotics. Reviewing the accumulated evidence and the most recent meta-analysis, it is clear that adjunctive dexamethasone confers a survival benefit in Streptococcus pneumoniae meningitis, and also a morbidity benefit which may be less pathogen-specific. This patient received appropriate investigation and treatment and fortunately made a full recovery, despite the adverse features on admission including seizures and reduced GCS. Vaccinations are a crucial tool in the prevention of meningitis."