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Previous Volume 336:708-716 March 6, 1997 Number 10 Next

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Few diseases have been affected more by the advent of antimicrobial therapy than bacterial meningitis. From its recognition in 1805 to the early 20th century, bacterial meningitis was fatal. Although the introduction of antibiotics made it curable,^1,2,3,4 morbidity and mortality from the disease remain unacceptably high. In a recent report, 61 percent of infants who survived gram-negative bacillary meningitis had developmental disabilities and neurologic sequelae.⁵ Similarly, in a recent review of 493 episodes of bacterial meningitis in adults, the overall case fatality rate was 25 percent.⁶ In this article we highlight epidemiologic trends, review principles of antibiotic pharmacokinetics, and provide . . . [Full Text of this Article]

Epidemiologic Trends of Therapeutic Importance

Principles of Antimicrobial Therapy for Bacterial Meningitis

The Need for Bactericidal Activity in Cerebrospinal Fluid

Factors Influencing Bactericidal Activity in Cerebrospinal Fluid

Potential Hazards of Bactericidal Activity in Cerebrospinal Fluid

Issues of Empirical Management

Timing of the Initial Dose of Antibiotic

Empirical Selection of Antibiotic

Empirical Glucocorticoid Therapy

Pathogen-Specific Therapy

S. pneumoniae

H. Influenzae

N. meningitidis

Less Common Pathogens

Duration of Antibiotic Therapy

Conclusions

Source Information

From the Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn. (V.J.Q.), and the Departments of Internal Medicine and Neurosurgery, University of Virginia School of Medicine, Charlottesville (W.M.S.).

Address reprint requests to Dr. Quagliarello at the Infectious Diseases Section, 800 LCI, Yale University School of Medicine, New Haven, CT 06510.

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