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Abstract
Successful treatment of bacterial meningitis in adults requires a rapid and accurate etiologic diagnosis, appropriate empirical therapy, and adjunctive treatment. Etiology and antimicrobial susceptibility of major pathogens of meningitis can differ by country. Ideal clinical practice guidelines for the management of bacterial meningitis in Korea should be based on studies conducted in Korea. We developed clinical practice guidelines for the management of bacterial meningitis in adults in Korea by adaptation of existing foreign guidelines. These guidelines were developed by the joint committee of the Korean Society for Chemotherapy, the Korean Society of Infectious Diseases, the Korean Neurological Association, the Korean Neurosurgical Society, and the Korean Society of Clinical Microbiology.
Figures and Tables
Table 3
Comparison of Cerebrospinal Fluid findings of Meningitis
CSF, cerebrospinal fluid
This table was modified from reference [3]
aIt may reach 250 mm H2O in obese adults.
bHigher cellularity in tuberculous meningitis has been occasionally observed in immunocompetent and BCG-vaccinated subjects soon after the initiation of anti-tuberculous therapy.
cNeutrophilic response in tuberculous meningitis is known with acute onset and in HIV patients. Lymphocytic pleocytosis may be seen in cases which have already been partially treated with antibiotics.
Table 4
Antibiotics Recommended for Empirical Therapy in Patients with Suspected Bacterial Meningitis
Table 5
Recommendations for Specific Antimicrobial Therapy in Bacterial Meningitis based on Isolated Microorganism and Susceptibility Test
All recommendations are A-III, unless otherwise indicated.
aCeftriaxone or cefotaxime
bRifampin is recommended to be added in combination with these drugs (B-III).
cMoxifloxacin
dImipenem also could be considered. However imipenem more likely to cause seizure than meropenem.
eAddition of an aminoglycoside should be considered.
fChoice of a specific antimicrobial agent must be guided by in vitro susceptibility test results.
gSusceptibility test should include the presence of high-level resistance to gentamicin (>500 µg/mL) and streptomycin (>2,000 µg/mL). Optimal synergistic antimicrobial therapy is not available for enterococci with high-level resistance to both gentamicin and streptomycin.
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