What is the role of antibiotics in the treatment of aseptic meningitis?

Updated: Jul 17, 2018
  • Author: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Given the potential for serious neurological morbidity and the persistently high mortality rates of bacterial meningitis, rapid institution of antibiotic coverage is essential when the diagnosis of bacterial meningitis is suspected. A third-generation intravenous cephalosporin is the customary choice.

Most studies suggest that rapid sterilization of CSF reduces mortality and long-term sequelae rates. Generally, if imaging studies are indicated before lumbar puncture, blood cultures and empiric antibiotic therapy should be instituted before the imaging studies; these are unlikely to decrease diagnostic sensitivity if CSF is tested for bacterial antigens.

A consensus conference recommended empirical antibiotic therapy for all patients with postoperative meningitis and treatment withdrawal after 48 or 72 hours if CSF culture results are negative. [15] This concept is not universally accepted. Zarrouk et al found that stopping antibiotic treatment after 3 days is effective and safe for patients with postoperative meningitis whose CSF culture results are negative. [16]

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