Glycerol and Bacterial Meningitis

Scientific efforts aimed at improving the prognosis of patients affected by severe diseases deserve to be highlighted and thoroughly evaluated for potential impact. Despite modern intensive care management and the advent of potent broadspectrum antimicrobial agents bacterial meningitis is still associated with unacceptably high rates of long-term-morbidity and case fatality. During the past 20 years comprehensive experimental and clinical studies have been performed to define the molecular pathophysiologic events involved in bacterial meningitis that are responsible for clinical manifestations and adverse outcomes. These studies have demonstrated that administration of dexamethasone before the first effective parenteral antibiotic dose reduced neurologic and/or audiologic sequelae in infants and children with Haemophilus influenzae meningitis and possibly in those infected with Streptococcus pneumoniae. Recently the benefit of corticosteroid therapy was confirmed in adults with pneumococcal meningitis. Nevertheless the favorable effects of treatment with dexamethasone are far from ideal and in selected situations they can be marginal or nonexistent. Children with delayed medical attention profound malnutrition HIV infection or treatment with suboptimal antibiotics (based on current bacterial drug-resistance profiles) are less likely than others to respond to adjunctive antiinflammatory therapy. These situations are commonly seen in poor regions of the world as illustrated in a clinical trial conducted in Malawi. Consequently novel and accessible forms of adjuvant therapy are clearly needed for the unique challenges faced by countries with limited economic and technical resources. (excerpt)