Bacterial meningitis: current therapy and possible future treatment options

Abstract

Despite targeted therapy, case–fatality rates and neurologic sequelae of bacterial meningitis remain unacceptably high. The poor outcome is mainly due to secondary systemic and intracranial complications. These complications seem to be both a consequence of the inflammatory response to the invading pathogen and release of bacterial components by the pathogen itself. Therefore, within the last decades, research has focused on the mechanism underlying immune regulation and the inhibition of bacterial lysis in order to identify new targets for adjuvant therapy. The scope of this article is to give an overview on current treatment strategies of bacterial meningitis, to summarize new insights on the pathophysiology of bacterial meningitis, and to give an outlook on new treatment strategies derived from experimental models.

Keywords::

• complement
• daptomycin
• dexamethasone
• matrix metalloproteinases
• rifampicin
• roscovitine
• Streptococcus pneumoniae

Acknowledgements

The authors would like to thank the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) for their support of the ESCMID Meningitis Study Group (EMESG) and, thus, providing a platform for concerted research on bacterial meningitis. They would also like to thank K Ogston for copyediting the manuscript.

Financial & competing interests disclosure

The authors’ research is funded by the Deutsche Forschungs-Gemeinschaft (Uwe Koedel), the Else Kroener-Fresenius-Foundation (Uwe Koedel), the Meningitis Research Foundation (Matthias Klein), the Gottfried und Julia Bangerter-Rhyner-Stiftung (Stephen Leib) and the Swiss National Science Foundation (31003A-138094/1; Stephen Leib and Denis Grandgirard). 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.

No writing assistance was utilized in the production of this manuscript.