Magazine article Drug Topics

Treating Bacterial Meningitis: A Potentially Fatal Disease

Magazine article Drug Topics

Treating Bacterial Meningitis: A Potentially Fatal Disease

Article excerpt

In a case that made national news, New Jersey health officials announced that a woman visiting the state on business was admitted to the hospital and died shortly thereafter of what was originally believed to have been fulminant bacterial pneumonia. She was later found to have meningococcemia, an illness that originates with the causative organism of meningitis.

This incident serves as a warning that bacterial meningitis is a serious infection-fatal if left untreated. The etiology must be identified and therapy initiated as quickly as possible. Another concern is the case does not seem to be isolated. More and more incidents of meningitis have been reported in recent years.

According to Ron Polk, Pharm.D., professor of pharmacy and medicine, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, the common causative agents of bacterial meningitis vary according to age group. "Streptococcus pneumoniae is seen across the adult population, while Neisseria meningitidis is primarily confined to relatively young adults (between the ages of 15 and 30). N. meningitidis is typically seen among people in close quarters, such as high school students or military recruits.

It is recommended that such persons, for example, college students, receive a quadrivalent meningococcal polysaccharide vaccine (Menomune, Aventis Pasteur). The vaccine is considered to be very safe and efficacious and has a duration of protection of three to five years.

Among neonates (birth to one or two months of age), group B streptococci and gram-negative bacteria may cause meningitis, although these are relatively uncommon, said Polk. Another cause is Leisteria, added Ralph Raasch, Pharm.D., associate professor, school of pharmacy, and associate clinical professor, school of medicine, University of North Carolina, Chapel Hill. Meningitis caused by Haemophilus influenzae used to be more common in children, but it has been basically eradicated with the introduction of the Hib (H. influenzae type b) vaccine.

Initial treatment to eradicate these bacteria is empiric, said Raasch. Antibiotics are used in combination to cover for the causative agent until that organism can be specifically identified and its drug susceptibility assessed by culturing the cerebrospinal fluid. Therapy can then be targeted to the specific pathogen. Patients with Neisseria meningitis usually receive ceftriaxone (Rocephin, Roche), and close contacts with the infected person are usually given fluoroquinolone as a single prophylaxis dose, according to Polk. Prophylaxis is necessary to eradicate the organism from the mouth flora, which is the organism's route of entry into the brain and cerebrospinal fluid. According to Raasch, cefotaxime (Claforan, Aventis) is another therapeutic option for those with Neisseria meningitis. …

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