Adjunctive therapy for bacterial meningitis: rationale for use, current status, and prospects for the future.

Despite the introduction of numerous therapeutic advances, the morbidity and mortality associated with bacterial meningitis remain significant. Research into the pathophysiology of bacterial meningitis has revealed that the inflammatory response resulting from bacterial invasion of the subarachnoid space is due in large part to the activity of host-derived mediators. This inflammatory response is ultimately responsible for the long-term neurological sequelae and death associated with bacterial meningitis. In vitro and in vivo models of bacterial meningitis have identified several points in the inflammatory cascade that may be amenable to therapeutic intervention. Numerous potential therapeutic agents that may limit inflammation of the subarachnoid space have been and are being developed, and trials in animal models and in humans are under way. The judicious use of safe and effective agents with demonstrated efficacy as adjuncts to bactericidal antimicrobial agents in the therapy for bacterial meningitis in humans may improve the prognosis of this disease.