Treatment Goals of Therapy

The introduction of antibiotic therapy and vaccines has reduced dramatically the mortality associated with bacterial meningitis.19 Prior to these advances, bacterial meningitis was almost universally fatal, and those few patients who survived often suffered from debilitating residual neurologic deficits, such as permanent hearing loss. Although significant improvements have been made, the fatality rate of pneumococ-cal meningitis remains above 20% likely due to its occurrence in debilitated patient populations.

The treatment goals for CNS infections are to prevent death and residual neurologic deficits, eradicate or control causative micro-organisms, ameliorate clinical signs and symptoms, and identify measures to prevent future infections (such as vaccination and suppressive therapy). These goals should be accomplished with minimal adverse drug reactions and interactions. Surgical debridement should be employed, if appropriate (as in postneurosurgical infections and brain abscess). Supportive care, consisting of hydration, electrolyte replacement, antipyretics, antiemetics, analgesics, antiepileptic drugs, and wound care (for surgical wounds), is an important adjunct to antimicrobial therapy, particularly early in the treatment course.

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