Treatment of Bacterial Meningitis and Other Central Nervous System Infections

Abstract

This chapter reviews the epidemiology and etiology of bacterial meningitis, the in vitro activities of the fluoroquinolones against various meningeal pathogens, the therapeutic principles (i.e., cerebrospinal fluid (CSF) penetration and pharmacodynamics) for use of the agents in meningitis, and clinical results in both experimental animal models and humans to place in perspective the potential usefulness of the fluoroquinolones in the treatment and prevention of bacterial meningitis. The efficacy of the fluoroquinolones in the treatment of other central nervous system (CNS) infections is also reviewed, where data are available on the utility of the agents. The chapter reviews the importance of different factors in the use of the fluoroquinolones in bacterial meningitis. An overview of the clinical efficacy of ciprofloxacin through 1986 in 3,981 patients and an analysis of the new drug application and published clinical experience with ciprofloxacin in 2,018 patients did not include any cases of bacterial meningitis. Several isolated case reports subsequently suggested the potential benefits of the fluoroquinolones in the therapy of bacterial meningitis. The limited published literature on the use of fluoroquinolones in humans suggests that the primary area of usefulness of these agents in patients with bacterial meningitis is for therapy of multidrugresistant gram-negative organisms (e.g., Pseudomonas aeruginosa) or when the response to conventional β-lactam therapy is slow.