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Clinical Microbiology Reviews, July 2003, p. 415-429, Vol. 16, No. 3
0893-8512/03/$08.00+0     DOI: 10.1128/CMR.16.3.415-429.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Reprogramming the Host Response in Bacterial Meningitis: How Best To Improve Outcome?

Wilhelmina Children's Hospital,¹ Eijkman-Winkler Institute for Microbiology,² Division of Acute Medicine and Infectious Diseases, Department of Medicine, University Medical Center, Utrecht, the Netherlands,³ and Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 38139⁴

Despite effective antibiotic therapy, bacterial meningitis is still associated with high morbidity and mortality in both children and adults. Animal studies have shown that the host inflammatory response induced by bacterial products in the subarachnoid space is associated with central nervous system injury. Thus, attenuation of inflammation early in the disease process might improve the outcome. The feasibility of such an approach is demonstrated by the reduction in neurologic sequelae achieved with adjuvant dexamethasone therapy. Increased understanding of the pathways of inflammation and neuronal damage has suggested rational new targets to modulate the host response in bacterial meningitis, but prediction of which agents would be optimal has been difficult. This review compares the future promise of benefit from the use of diverse adjuvant agents. It appears unlikely that inhibition of a single proinflammatory mediator will prove useful in clinical practice, but several avenues to reprogram a wider array of mediators simultaneously are encouraging. Particularly promising are efforts to adjust combinations of cytokines, to inhibit neuronal apoptosis and to enhance brain repair.

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