Corticosteroids and bacterial meningitis

Despite timely and appropriate antimicrobial therapy of bacterial meningitis, neurologic sequelae still occur in some children. This also remains true for the third generation cephalosporins such as ceftriaxone and cefotaxime despite their extraordinary high bactericidal titers in the cerebrospinal fluid of children with bacterial meningitis. The most effective way to prevent neurologic damage in these patients is to prevent the infection from developing in the first place. This may be achievable in the very near future for meningitis due to Haemophilus influenzae type b, the most common organism causing meningitis in children in many parts of the world. Unfortunately, even though such means of prevention may be available or under development, ensuring that all children receive these immunizations is very difficult to accomplish. Furthermore, some forms of bacterial meningitis are not likely to be preventable by immunization or other methods and thus efforts to develop new means to minimize the neurologic damage due to meningitis remain important. One such effort involves the use of antiinflammatory agents in addition to antimicrobial therapy for the treatment of this infection. This review will focus on the role of one such antiinflammatory agent, corticosteroids, as adjunctive therapy for bacterial meningitis.