Meningitis

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Treatment

Treatment is determined by the type of meningitis and the organism causing the disease.

Viral meningitis usually requires only symptom relief (palliative care). Palliative care may include bed rest, increased fluid intake to prevent dehydration, and analgesics (e.g., aspirin, acetaminophen) to reduce fever and relieve body aches.

Meningitis caused by herpesvirus can be treated using antiviral medication such as acyclovir (Zovirax®) or ribavirin (Virazole®). Side effects of these medications include nausea, vomiting, and headache.

Suspected bacterial meningitis requires prompt intravenous (IV) antibiotic treatment in the hospital to prevent serious complications and neurological damage. If symptoms are severe, IV treatment may be initiated before the lumbar puncture is performed.

Severly ill patients are treated immediately with a combination of antibiotics. Penicillin combined with a cephalosporin (e.g., ceftriaxone [Rocephin®], cefotaxime [Claforan®]) is commonly used. Because some bacteria are resistant to these drugs, vancomycin, with or without rifampin, ampicillin, and gentamicin may be added to cover resistant pneumococcal strains of bacteria and Listeria monocytogenes.

Side effects include abdominal pain, nausea, vomiting, and diarrhea. Once the CSF culture has revealed the disease-causing organism (pathogen), antibiotic treatment is adjusted accordingly.

Amphotericin B and fluconazole (Diflucan®) are effective against most disease-causing fungi and are the drugs of choice for treatment of fungal meningitis. They may be administered singly or as combined therapy. Both drugs are well tolerated in most patients.

Possible side effects of fluconazole include nausea and vomiting, diarrhea, headache, skin rash, and abdominal pain. Intravenously administered amphotericin B may produce the same side effects, as well as shaking chills and fever, slowed heart rate, low blood pressure (hypotension), body ache, and weight loss.

Parasitic meningitis usually is treated with a benzimidazole derivative or other antihelminthic agent.

Complications that develop also must be treated. Corticosteroids (e.g., dexamethasone) may be administered to reduce the risk for hearing loss. Increased intracranial pressure may be reduced with diuretics (e.g., mannitol) and a surgically placed shunt that drains excess fluid.

Prognosis

Bacterial meningitis is fatal in as many as 25% of cases. Patients with meningitis caused by Streptococcus pneumoniae and patients younger than 2 years old or over the age of 60 have a poor prognosis. Prompt medical treatment (i.e., antibiotics) reduces the risk for dying from bacterial meningitis to less than 15%.

Viral meningitis usually resolves in 7–10 days and is fatal in fewer than 1% of cases.

Prevention

Immunization with the vaccines listed below is the most effective way to prevent meningitis:

• Haemophilus influenzae type b
  
• MMR (measles, mumps, rubella)
  
• Neisseria meningitides
  
• Pneumococcal (children aged 2 and younger)
  
• Streptococcus pneumoniae
  
• Varicella (chickenpox)
  

Medications such as rifampin (Rifadin®), ceftriaxone (Duricef®), and ciprofloxacin (Cipro®) may be used to prevent the development of bacterial meningitis in people exposed to the disease.

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