Akute bakterielle Meningitis: Neues aus Forschung und Klinik

Abstract

Until the introduction of antibiotics in the 1930 s and 1940 s, acute bacterial meningitis was fatal in the vast majority of cases. Since then it has become curable with a variable mortality and morbidity rate depending on individual pathogens and patients. During the past 20 years, we have witnessed significant changes in the epidemiology and treatment of acute bacterial meningitis. The most important epidemiological changes are (I) the near-eradication of meningitis due to HAEMOPHILUS INFLUENZAE type B as well as the decline in the incidence of pneumococcal and meningococcal meningitis in countries that have introduced the respective immunisation programmes, and (II) the emergence of antimicrobial resistance among meningeal pathogens which is of particular importance for the clinical management of the disease. The major therapeutic change is that adjuvant dexamethasone therapy has been demonstrated to be beneficial, particularly in adults with pneumococcal meningitis. It became also evident that time from arrival at the hospital to administration of the first dose of antibiotics is a crucial independent factor that influences outcome. Here we review (I) the epidemiological characteristics of acute bacterial meningitis, (II) the impact of vaccination programmes on the epidemiology, (III) the clinical and laboratory presentation of the disease and (IV) the antibiotic regimens and adjuvant treatment options that are currently recommended for its treatment. We further review (V) current concepts of the pathophysiology of the disease - using the example of pneumococcal meningitis - with an emphasis on promising targets for novel adjunctive therapy in acute bacterial meningitis.