Download PDF
CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2019; 06(02): 145-152
DOI: 10.1055/s-0039-1692868
Review Article
Indian Society of Neuroanaesthesiology and Critical Care

Pharmacologic Treatment of Meningitis and Encephalitis in Adult Patients

Andrew K. Treister
1   Department of Neurology, Oregon Health & Science University, Portland, Oregon, United States
,
Ines P. Koerner
2   Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, United States
› Author Affiliations
Further Information

Publication History

Received: 05 February 2019

Accepted after revision: 19 May 2019

Publication Date:
19 June 2019 (online)

Also available at
   Permissions and Reprints

Abstract

Meningitis and encephalitis are two inflammatory, often infectious, disorders of the meninges and the central nervous system. Both are associated with significant morbidity and mortality, and require early and aggressive targeted treatment. This article reviews pharmacologic treatment strategies for infectious meningitis and encephalitis, using the latest available research and guidelines. It provides an overview of empiric antimicrobial treatment approaches for a variety of organisms, including a discussion of trends in antibiotic resistance where applicable. Key steps in diagnosis and general management are briefly reviewed.

Keywords

meningitis - encephalitis - antibiotic resistance
 

  • References

  • 1 Tyler KL. Acute viral encephalitis. N Engl J Med 2018; 379 (06) 557-566
    CrossrefPubMedGoogle Scholar
  • 2 Costerus JM, Brouwer MC, Bijlsma MW, van de Beek D. Community-acquired bacterial meningitis. Curr Opin Infect Dis 2017; 30 (01) 135-141
    CrossrefPubMedGoogle Scholar
  • 3 Giovane RA, Lavender PD. Central nervous system infections. Prim Care 2018; 45 (03) 505-518
    CrossrefPubMedGoogle Scholar
  • 4 Tunkel AR, Hasbun R, Bhimraj A. et al. 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis. 2017 doi: 10.1093/cid/ciw861
    PubMedGoogle Scholar
  • 5 Auburtin M, Wolff M, Charpentier J. et al. Detrimental role of delayed antibiotic administration and penicillin-nonsusceptible strains in adult intensive care unit patients with pneumococcal meningitis: the PNEUMOREA prospective multicenter study. Crit Care Med 2006; 34 (11) 2758-2765
    CrossrefPubMedGoogle Scholar
  • 6 van Ettekoven CN, van de Beek D, Brouwer MC. Update on community-acquired bacterial meningitis: guidance and challenges. Clin Microbiol Infect 2017; 23 (09) 601-606
    CrossrefPubMedGoogle Scholar
  • 7 Khatib U, van de Beek D, Lees JA, Brouwer MC. Adults with suspected central nervous system infection: a prospective study of diagnostic accuracy. J Infect 2017; 74 (01) 1-9
    CrossrefPubMedGoogle Scholar
  • 8 Sanaei D A, Alizadeh S, Karimi A, Khalifeh M, Shoja SA. Diagnostic value of lactate, procalcitonin, ferritin, serum-C-reactive protein, and other biomarkers in bacterial and viral meningitis: a cross-sectional study. Medicine (Baltimore) 2017; 96 (35) e7637
    PubMedGoogle Scholar
  • 9 Vikse J, Henry BM, Roy J, Ramakrishnan PK, Tomaszewski KA, Walocha JA. The role of serum procalcitonin in the diagnosis of bacterial meningitis in adults: a systematic review and meta-analysis. Int J Infect Dis 2015; 38: 68-76
    CrossrefPubMedGoogle Scholar
  • 10 Viallon A, Botelho-Nevers E, Zeni F. Clinical decision rules for acute bacterial meningitis: current insights. Open Access Emerg Med 2016; 8: 7-16
    PubMedGoogle Scholar
  • 11 McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. Lancet 2016; 38810063: 3036-3047
    PubMedGoogle Scholar
  • 12 McIntyre PB, O'Brien KL, Greenwood B, van de Beek D. Effect of vaccines on bacterial meningitis worldwide. Lancet 2012; 3809854: 1703-1711
    PubMedGoogle Scholar
  • 13 van de Beek D, Brouwer MC, Thwaites GE, Tunkel AR. Advances in treatment of bacterial meningitis. Lancet 2012; 3809854: 1693-1702
    PubMedGoogle Scholar
  • 14 Verghese VP, Veeraraghavan B, Jayaraman R. et al. Increasing incidence of penicillin- and cefotaxime-resistant. Streptococcus pneumoniae. causing meningitis in India: time for revision of treatment guidelines?. Indian J Med Microbiol 2017; 35 (02) 228-236
    CrossrefPubMedGoogle Scholar
  • 15 Thigpen MC, Whitney CG, Messonnier NE. et al; Emerging Infections Programs Network. Bacterial meningitis in the United States, 1998-2007. N Engl J Med 2011; 364 (21) 2016-2025
    CrossrefPubMedGoogle Scholar
  • 16 van de Beek D, de Gans J, Tunkel AR, Wijdicks EF. Community-acquired bacterial meningitis in adults. N Engl J Med 2006; 354 (01) 44-53
    CrossrefPubMedGoogle Scholar
  • 17 Green C, Moore CA, Mahajan A, Bajaj K. A simple approach to pneumococcal vaccination in adults. J Glob Infect Dis 2018; 10 (03) 159-162
    CrossrefPubMedGoogle Scholar
  • 18 Tunkel AR, Hartman BJ, Kaplan SL. et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39 (09) 1267-1284
    CrossrefPubMedGoogle Scholar
  • 19 Brouwer MC, McIntyre P, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2015; (09) CD004405
    PubMedGoogle Scholar
  • 20 Cottagnoud P, Täuber MG. Fluoroquinolones in the treatment of meningitis. Curr Infect Dis Rep 2003; 5 (04) 329-336
    CrossrefPubMedGoogle Scholar
  • 21 Kanellakopoulou K, Pagoulatou A, Stroumpoulis K. et al. Pharmacokinetics of moxifloxacin in non-inflamed cerebrospinal fluid of humans: implication for a bactericidal effect. J Antimicrob Chemother 2008; 61 (06) 1328-1331
    CrossrefPubMedGoogle Scholar
  • 22 Heckenberg SG, de Gans J, Brouwer MC. et al. Clinical features, outcome, and meningococcal genotype in 258 adults with meningococcal meningitis: a prospective cohort study. Medicine (Baltimore) 2008; 87 (04) 185-192
    PubMedGoogle Scholar
  • 23 Nathan N, Borel T, Djibo A. et al. Ceftriaxone as effective as long-acting chloramphenicol in short-course treatment of meningococcal meningitis during epidemics: a randomised non-inferiority study. Lancet 2005; 3669482: 308-313
    PubMedGoogle Scholar
  • 24 Mylonakis E, Hohmann EL, Calderwood SB. Central nervous system infection with. Listeria monocytogenes. . 33 year's experience at a general hospital and review of 776 episodes from the literature. Medicine (Baltimore) 1998; 77 (05) 313-336
    PubMedGoogle Scholar
  • 25 van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004; 351 (18) 1849-1859
    CrossrefPubMedGoogle Scholar
  • 26 Zunt JR. Tuberculosis of the central nervous system. Continuum (Minneap Minn) 2018; 24 (05) Neuroinfectious Disease) 1422-1438
    PubMedGoogle Scholar
  • 27 World Health Organization. Guidelines for Treatment of Drug-Susceptible Tuberculosis and Patient Care. Published 2017 (2017 Update). Available at: https://www.who.int/tb/publications/2017/dstb_guidance_2017/en/ Accessed December 18, 2018
    PubMedGoogle Scholar
  • 28 Iseman MD. Treatment of multidrug-resistant tuberculosis. N Engl J Med 1993; 329 (11) 784-791
    CrossrefPubMedGoogle Scholar
  • 29 Garg RK, Rizvi I, Malhotra HS, Uniyal R, Kumar N. Management of complex tuberculosis cases: a focus on drug-resistant tuberculous meningitis. Expert Rev Anti Infect Ther 2018; 16 (11) 813-831
    CrossrefPubMedGoogle Scholar
  • 30 Halperin JJ. Neuroborreliosis and neurosyphilis. Continuum (Minneap Minn) 2018; 24 (05) Neuroinfectious Disease 1439-1458
    PubMedGoogle Scholar
  • 31 Halperin JJ, Shapiro ED, Logigian E. et al; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2007; 69 (01) 91-102
    CrossrefPubMedGoogle Scholar
  • 32 Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines. Published 2015. Available at: https://www.cdc.gov/std/tg2015/default.htm Accessed December 23, 2018
    PubMedGoogle Scholar
  • 33 Lewin III JJ, Cook AM, Gonzales C. et al. Current practices of intraventricular antibiotic therapy in the treatment of meningitis and ventriculitis: results from a multicenter retrospective cohort study. Neurocrit Care 2019; 30 (03) 609-616
    CrossrefPubMedGoogle Scholar
  • 34 Mrowczynski OD, Langan ST, Rizk EB. Intra-cerebrospinal fluid antibiotics to treat central nervous system infections: a review and update. Clin Neurol Neurosurg 2018; 170: 140-158
    CrossrefPubMedGoogle Scholar
  • 35 van de Beek D, Drake JM, Tunkel AR. Nosocomial bacterial meningitis. N Engl J Med 2010; 362 (02) 146-154
    CrossrefPubMedGoogle Scholar
  • 36 Steiner I, Benninger F. Manifestations of herpes virus infections in the nervous system. Neurol Clin 2018; 36 (04) 725-738
    CrossrefPubMedGoogle Scholar
  • 37 McGrath N, Anderson NE, Croxson MC, Powell KF. Herpes simplex encephalitis treated with acyclovir: diagnosis and long term outcome. J Neurol Neurosurg Psychiatry 1997; 63 (03) 321-326
    CrossrefPubMedGoogle Scholar
  • 38 Raschilas F, Wolff M, Delatour F. et al. Outcome of and prognostic factors for herpes simplex encephalitis in adult patients: results of a multicenter study. Clin Infect Dis 2002; 35 (03) 254-260
    CrossrefPubMedGoogle Scholar
  • 39 Maschke M, Kastrup O, Diener HC. CNS manifestations of cytomegalovirus infections: diagnosis and treatment. CNS Drugs 2002; 16 (05) 303-315
    CrossrefPubMedGoogle Scholar
  • 40 Saylor D. Neurologic complications of human immunodeficiency virus infection. Continuum (Minneap Minn) 2018; 24 (05) Neuroinfectious Disease) 1397-1421
    PubMedGoogle Scholar
  • 41 Heaton RK, Franklin DR, Ellis RJ. et al; CHARTER Group; HNRC Group. HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol 2011; 17 (01) 3-16
    CrossrefPubMedGoogle Scholar
  • 42 Molloy SF, Kanyama C, Heyderman RS. et al; ACTA Trial Study Team. Antifungal combinations for treatment of cryptococcal meningitis in Africa. N Engl J Med 2018; 15 378 (11) 1004-1017
    PubMedGoogle Scholar
  • 43 Gottfredsson M, Perfect JR. Fungal meningitis. Semin Neurol 2000; 20 (03) 307-322
    Article in Thieme ConnectPubMedGoogle Scholar
  • 44 Góralska K, Blaszkowska J, Dzikowiec M. Neuroinfections caused by fungi. Infection 2018; 46 (04) 443-459
    CrossrefPubMedGoogle Scholar
  • 45 McCarthy M, Rosengart A, Schuetz AN, Kontoyiannis DP, Walsh TJ. Mold infections of the central nervous system. N Engl J Med 2014; 371 (02) 150-160
    CrossrefPubMedGoogle Scholar
  • 46 Panel on Opportunistic Infections in Hiv-Infected Adults and Adolescents, Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Published2018. Available at: http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf Accessed January 1, 2019
    PubMedGoogle Scholar
  • 47 Al-Diwani A, Handel A, Townsend L. et al. The psychopathology of NMDAR-antibody encephalitis in adults: a systematic review and phenotypic analysis of individual patient data. Lancet Psychiatry 2019; 6 (03) 235-246
    CrossrefPubMedGoogle Scholar
  • 48 Hermetter C, Fazekas F, Hochmeister S. Systematic review: syndromes, early diagnosis, and treatment in autoimmune encephalitis. Front Neurol 2018; 9: 706
    CrossrefPubMedGoogle Scholar