Despite the presence of effective antibacterial drugs and their use in the treatment of acute bacterial meningitis (BM), the mortality rate for patients with this pathology continues to be quite high in developing and economically developed countries. In a review study by M.T. Fitch et al. (United States), a study was conducted and a comparative evaluation of current recommendations for the management of patients suspected of having bacterial meningitis. On the basis of generalized data, the authors of the work identified the key aspects of the diagnosis and treatment of patients suffering from this pathology.

The process of diagnosis of BM traditionally begins with a history and a physical examination. Although, according to a certain number of publications, these methods are not considered as sufficiently informative for the diagnosis of BM, they make it possible to suspect the presence of an infection. According to the results of a study, 99% of patients with bacterial meningitis have at least 1 of the following 4 symptoms: headache, fever, stiff neck and violation of the mental state. These data are confirmed by the results of a recent meta-analysis, which showed that the absence of fever, stiff neck and changes in mental state eliminates the diagnosis of meningitis with a probability of 99-100 %. Other symptoms of infection are considered less informative. Thus, in most adult patients with bacterial meningitis, the cutaneous manifestations of infection (rashes with meningococcemia, etc.) are weakly expressed or absent (11% in a retrospective study and 26% in a prospective study). The symptoms of Koenig and Brudzinsky, as well as the signs of meningism in most cases, are also not sufficiently expressed to confirm or exclude the diagnosis of bacterial meningitis.

One of the main diagnostic criteria for bacterial meningitis is considered to be the results of a study on cerebrospinal fluid. Although an increase in intracranial pressure increases the risk of spinal hernia formation after this procedure, the probability of such an event is relatively low, which allows a spinal puncture in case of suspected BM without CT scan in the absence seizures, immunodeficiency, neoplasms, optic disc edema, focal neurological symptoms and severe disturbances of consciousness. For meningitis with bacterial etiology, an increase in the number of leukocytes to 1000-10000 / μl (variations less than 100 - greater than 10,000) is characteristic, the proportion of neutrophils of which more than 80%, an increase in the protein concentration and a decrease in the concentration of glucose in the cerebrospinal fluid, while in case of viral etiology of the process, the number of leukocytes 300 / μl (variations less than 100-1000), and the proportion of neutrophils among them does not exceed 20%; protein and glucose concentrations are generally within normal limits. However, the results of the examination of the cerebrospinal fluid cannot be considered as an absolute criterion for the differential diagnosis of meningitis.

Most authors recommend that the start of adequate antibiotic therapy be as soon as possible. It has been shown that the introduction of the first dose of antibiotic, even in the pre-hospital stage, can significantly increase the survival of patients with this pathology. Before identifying the causative agent of infection, the use of broad-spectrum antibiotics is preferable, given the local characteristics of the etiology of bacterial meningitis and antibiotic resistance. As the drug of choice for empirical therapy, the introduction of third generation cephalosporins (cefotaxime or ceftriaxone) in appropriate doses is recommended. Due to the increased frequency of isolation of multidrug-resistant strains of Streptococcus pneumoniae in many parts of the world (up to 35% in the United States), most experts suggest including vancomycin in the initial empirical treatment regimen for adult patients with bacterial meningitis. Ampicillin should also be prescribed to patients over the age of 50, since in this age group the likelihood of developing an infection caused by Listeria monocytogenes is high.

A severe inflammatory reaction accompanying the course of a bacterial infection of the brain can lead to death in patients with bacterial meningitis, despite adequate antibiotic therapy. Therefore, the use of anti-inflammatory drugs, namely glucocorticoids, is an integral part of the successful treatment of this life-threatening infection. Since now, reliable efficacy of BM has only been demonstrated for dexamethasone, it is recommended to administer this drug to all adult patients suspected of BM at a dose of 10 mg intravenously simultaneously with the first dose of the antibacterial drug.