Treatment of gram-negative bacillary meningitis in adults.

Abstract

Among adults, Gram-negative bacillary meningitis (excluding that due to Hemophilus influenzae) is most frequently associated with chronic systemic disease or invasive procedures of the central nervous system, including accidental trauma. Literature of the past 20 years reports mainly single cases and suggests a high mortality despite antibiotics use. Optimal antimicrobial therapy should provide wide Gram-negative activity and effective cerebrospinal fluid concentrations before sensitivity data are available. Thus chloramphenicol, polymyxin B, kanamycin, carbenicillin, and gentamicin are the most useful agents for initial treatment. The diffusion of kanamycin and gentamicin from blood to cerebrospinal fluid is inconsistent, and intrathecal administration is warranted when aminoglycosides or polymyxins are used for the treatment of adults. The use of two drugs may be most effective as initial therapy. Antibiotics should be selected for the central nervous system pharmacology, compatibility, and antimicrobial spectra of the most effective agents.