Anti-Inflammatory Adjuvant Agents in Bacterial Meningitis

Bacterial meningitis is associated with high morbidity and mortality in both children and adults. The overall mortality rate from bacterial meningitis is 5-10% despite the availability of effective antibiotics and 5-40% of the survivors has severe sequelae. Work in animal models has demonstrated that the host inflammatory response induced by bacterial products in the subarachnoid space in bacterial meningitis is associated with central nervous system (CNS) injury. This has led to the concept that attenuation of inflammation early in the disease process might improve outcome. The increased understanding of the pathogenesis of inflammation and CNS damage has suggested rational targets to modulate the host inflammatory response and prevent irreversal neuronal injury. This review focuses on the adjuvant use of corticosteroids, pentoxifylline, and other agents in bacterial meningitis. In addition novel potential targets such as transcription factor NFκB and caspases are discussed.