Bacterial meningitis: new treatment options to reduce the risk of brain damage

ABSTRACT

Introduction: Bacterial meningitis (BM) is a medical emergency and its etiology varies according to the age group and geographic area. Studies have shown that brain damage, sequelae and neuropsychological deficits depend not only on the direct deleterious action of the pathogens, but also on the host defenses themselves.

Areas covered: Corticosteroids (CS) were the first drugs used with the intent to limit the exaggerated host response. However, as steroid addition to antibiotics is frequently unsatisfactory, other measures have been suggested. In this study, the most important adjuvant therapies that are potentially useful to limit the neuropsychological damage of BM are discussed.

Expert opinion: The pathophysiological mechanisms leading to the development of brain damage are not completely defined. Moreover, the efficacy of adjuvant therapies can vary according to the aetiologic cause of BM, and differences in immune system function of the host can play a relevant role in the expression of inflammation and related problems. It is likely that none of the measures with demonstrated efficacy in animal models can be translated into clinical practice in the next few years, suggesting that to reduce the total burden of BM, the increased use of vaccines seems to be the best solution.

KEYWORDS:

• Bacterial meningitis
• corticosteroid
• daptomycin
• glycerol
• meningitis
• metalloproteinase modulator

Article highlights

• Bacterial meningitis (BM) is a medical emergency and its aetiology varies significantly according to the age group and geographic area.

• The use of effective preventive measures, such as vaccines against Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b, has significantly reduced the incidence of BM cases due to these pathogens.

• Antibiotic treatment has significantly reduced mortality and neurological complications associated with BM, although mortality remains at approximately 10% and neuropsychological complications are diagnosed in up to 30% of survivors.

• Although drugs that significantly interfere with one or more of the steps that characterize the host response to infection have been suggested, dexamethasone remains the only adjunctive measure systematically recommended in all the international approved protocols for BM treatment.

• Interventions including nonbacteriolytic antibiotics, modulators of neutrophil activity, osmotic agents, metalloproteinase modulators, paracetamol hypothermia, complement antagonists and antioxidants have been proposed. However, most of these interventions do lack human studies.

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Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The authors are supported by the Paediatric Section of the Department of Surgical and Biomedical Sciences, the Università degli Studi di Perugia, Perugia (PED-2019-06).