Clinical management of bacterial meningitis based on the Japanese clinical guidelines 2014

Abstract

Recent clinical management of bacterial meningitis (BM) is reviewed. Bacterial meningitis can present as an acute fulminant disease that progress rapidly in a few hours or a subacute infection that progressively worsens during several days. The mortality rate with BM and the frequency of neurologic sequelae among those who survive are high. BM is thus a life–threatening neurological emergency. Early recognition, efficient decision–making, and rapid institution of therapy can be lifesaving. Empirical therapy should be initiated promptly whenever BM is a significant diagnostic consideration.

Infectious Diseases Society of America (2004) and European Federation of Neurological Societies (2008) reported initial management approach of BM. The guidelines for the clinical management of BM in Japan were published in 2007, and the revision was also published in December 2014. These initial therapeutic managements for BM differ for every country. The reasons for the different initial therapeutic management are based on the following strategies. The choice of specific antimicrobial agents for initial treatment is based on the current knowledge of antimicrobial susceptibility patterns of these pathogens in the area. For initial treatment, the assumption should be that antimicrobial resistance is likely. The choice of empirical antibiotic in BM may be influenced by a number of factors, including patient's age, systemic symptoms and local pattern of bacterial resistance. If there are no epidemiologic evidences in Japan, a committee investigates it and builds data in the revised Japanese guidelines 2014 for the clinical management of BM.