Treatment Meningitis

The first therapeutic step is to manage shock and systemic hypotension, which immediately threatens the patient's life. Intravenous infusions of crystalloids are administered. 

Securing central venous access and the airway with an oxygen supply is a life-saving act in patients with impaired consciousness.

The mainstay of therapy for purulent meningitis is early start of antibiotic therapy. 

The first dose of broad-spectrum antibiotics is empirical, that is, even if we do not know what the causative agent is, we administer antibiotics according to the clinical picture and the therapist's assumption. 

Recovery from such treatment must be very rapid, usually within 30 minutes of the patient's admission to hospital.

Therefore, there is no time and space for lengthy tests.

If symptoms suggest purulent meningitis, regardless of the causative agent, antibiotic treatment is given. 

Generation III cephalosporins are used in the non-immunodeficient adult population and in children from 3 months of age. They are very sensitive to pneumococci and even without combination with vancomycin or rifampicin.

With an allergy to cephalosporins, chloramphenicol is chosen. With caution, the antibiotic meropenem may also be chosen. 

In infants up to 3 months of age, treatment is boosted with ampicillin, because at this age there is a high risk that Listeria monocytogenes may be the causative agent of suppurative meningitis.

Also, this combination (third-generation cephalosporins and ampicillin) is used in patients over 50 years of age and in people with immunodeficiencies, such as those with diabetes, cirrhosis of the liver, or alcohol dependence. 

After evaluation of the microbiological examination and determination of the causative agent of the infection, antibiotic therapy is adjusted.

For example, if it is a pneumococcal or meningococcal meningitis, penicillin G is administered.If it is a listeria infection, ampicillin is combined with aminoglycosides. 

A frequent complication is a history of allergy to ampicillin. Then meropenem, vancomycin, linezolid, or cotrimoxazole come into consideration. 

A special group is nosocomial meningitis. 

These are infections caused by bacteria that live in the hospital environment and are transmitted by the hands of staff. Nosocomial infections of the central nervous system are very common in patients after neurosurgery when a long hospital stay is still needed.

Since these bacteria are already accustomed to a hospital environment saturated with antibiotics, many of the common antibiotics lose their effectiveness. Such bacteria are called multidrug-resistant and are very difficult to treat from a therapeutic point of view.

There are antibiotics for these types of bacteria that are protected and their use is limited to this case only. Such an antibiotic is, for example, meropenem. 

Immunodeficient patients are at high risk of cerebellar involvement by fungal infection. In this case, antifungal drugs are applied, namely fluconazole, in cryptococcal infection, amphotericin B is chosen. 

The length of treatment depends on the type of causative agent. For meningococci, haemophilus and pneumococci, intravenous treatment lasts 7 to 10 days. For staphylococcal infection, it is 14 days. If Listeria monocytogenes is found to be the causative agent, therapy is stretched to 21 days. 

If antibiotic treatment is unsuccessful, neurosurgical intervention is resorted to, which is drainage. Such a situation arises in staphylococcal meningitis, which can be a complication of an established shunt into the liquor ducts. 

Supportive treatment of purulent meningitis

Despite early initiation of antibiotic treatment, the patient's clinical condition may continue to deteriorate. Even during treatment, a seemingly unremarkable clinical picture may be accompanied by impaired consciousness, convulsions, paralysis, sepsis and septic shock.

Therefore, any patient with purulent meningitis should be admitted to a monitored bed in an intensive care unit for several days. 

In such a bed, in addition to antibiotic treatment, the patient is given corticotherapy (administration of corticosteroids to manage brain swelling), preventive therapy for convulsions (benzodiazepines and antiepileptics) and anti-shock therapy with crystalloid infusions. Among other things, analgesic and antipyretic therapy for high fevers. 

If the impairment of consciousness deepens and unconsciousness or even coma occurs, it is necessary to connect the patient to artificial pulmonary ventilation. 

The progression of neurological symptoms depends on the management of increased intracranial pressure, in which cerebral blood supply, i.e. cerebral perfusion, decreases. Initially, adequate perfusion is achieved by correct positioning of the patient by raising the head 15 to 30 degrees above the rest of the body. 

In patients who do not have a stable blood circulation, infusion of furosemide and mannitol is resorted to, which will ensure the swelling and expulsion of excess fluid from the body.