Use of corticosteroids and other adjunct therapies for acute bacterial meningitis in adults.

Acute bacterial meningitis is associated with high morbidity and mortality despite the availability of effective antibiotics. The inflammatory response induced by bacterial products in the subarachnoid space is responsible for neuronal injury. The use of adjuvant therapy in acute bacterial meningitis draws its rationale from the notion of arresting the inflammatory cascade at an early stage of the disease to improve clinical outcome. Corticosteroids have been studied extensively in these patients and seems effective in selective groups of patients, particularly those with pneumococcal meningitis. Glycerol appears harmful in adults with acute bacterial meningitis. Experimental models suggest promising role of newer anti-inflammatory drugs such as antioxidants, inhibitors of Tumor Necrosis Factor-α, poly-ADP-ribose inhibitors, caspase inhibitors, brain-derived neurotrophic factor etc.; however clinical trials are still lacking for these novel potential targets in acute bacterial meningitis. This review focuses on corticosteroids with comments on the role of other potential adjuvant therapy in adults with acute bacterial meningitis.