Partner Drugs: A New Outlook for Bacterial Meningitis
Authors: Elaine Tuomanen
Journal: Annals of Internal Medicine (1988)

Editorials1 November 1988Partner Drugs: A New Outlook for Bacterial MeningitisElaine Tuomanen, MD, CMElaine Tuomanen, MD, CMSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-109-9-690 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptSurprisingly, the morbidity and mortality rates from bacterial meningitis have remained stable since the advent of antibiotics in the 1930s. A persistent mortality rate of 30% for pneumococcal meningitis (1) is not acceptable in the current chemotherapeutic era, yet the development of more highly bactericidal antibiotics has not improved disease outcome. Recently, important clues have emerged to explain this paradox. The new concept propelling changes in therapeutic regimens is that reducing inflammation is required in addition to killing bacteria in order to minimize neurologic injury during infections in the subarachnoid space. Within the next 5 years introduction of ancillary modes...References1. Bacterial meningitis and meningococcemia—United States, 1978. MMWR. 1979;28:277-9. Google Scholar2. QuagliarelloLongScheld VWW. Morphologic alterations of the blood-brain barrier with experimental meningitis in the rat. Temporal sequence and role of encapsulation. J Clin Invest. 1986;77:1084-95. CrossrefMedlineGoogle Scholar3. ScheldQuagliarelloLesse WVA. Selected aspects of the pathogenesis and pathophysiology of bacterial meningitis. In: Williamson JD, Burnie J, eds. Bacterial Meningitis. London: Academic Press; 1987:1-28. Google Scholar4. ScheldDaceyWinnWelshJaneSande WRHJJM. Cerebrospinal fluid outflow resistance in rabbits with experimental meningitis. J Clin Invest. 1980;66:243-53. CrossrefMedlineGoogle Scholar5. TauberKhayam-BashiSande MHM. Effects of ampicillin and corticosteroids on brain water content, cerebrospinal fluid pressure, and cerebrospinal fluid lactate levels in experimental pneumococcal meningitis. J Infect Dis. 1985;151:528-34. CrossrefMedlineGoogle Scholar6. TauberBorschbergSande MUM. Influence of granulocytes on brain edema, intracranial pressure, and cerebrospinal fluid concentrations of lactate and protein in experimental meningitis. J Infect Dis. 1988;157:456-64. CrossrefMedlineGoogle Scholar7. TuomanenTomaszHengstlerZak EABO. The relative role of bacterial cell wall and capsule in the induction of inflammation in pneumococcal meningitis. J Infect Dis. 1985;151:535-40. CrossrefMedlineGoogle Scholar8. TuomanenLiuHengstlerZakTomasz EHBOA. The induction of meningeal inflammation by components of the pneumococcal cell wall. J Infect Dis. 1985;151:859-68. CrossrefMedlineGoogle Scholar9. TauberShiblHackbarthLarrickSande MACJM. Antibiotic therapy, endotoxin concentration in cerebrospinal fluid, and brain edema in experimental Escherichia coli meningitis in rabbits. J Infect Dis. 1987;156:456-62. CrossrefMedlineGoogle Scholar10. TauberTuomanenZakSande MEOM. Increased intracranial pressure induced by pneumococcal cell walls. In: Program and Abstracts of the 25th Interscience Conference on Antimicrobial Agents and Chemotherapy. Minneapolis, Minnesota: American Society for Microbiology; 1985 (Abstract 683). Google Scholar11. ErnstHartialaGoldsteinSande JKIM. Complement (C5)-derived chemotactic activity accounts for accumulation of polymorphonuclear leukocytes in cerebrospinal fluid of rabbits with pneumococcal meningitis. Infect Immun. 1984;46:81-6. CrossrefMedlineGoogle Scholar12. TuomanenHengstlerZakTomasz EBOA. The role of complement in inflammation during experimental pneumococcal meningitis. Microb Pathogen. 1986;1:15-32. CrossrefMedlineGoogle Scholar13. TuomanenHengstlerRichBrayZak EBRMO. Nonsteroidal anti-inflammatory agents in the therapy for experimental pneumococcal meningitis. J Infect Dis. 1987;155:985-90. CrossrefMedlineGoogle Scholar14. QuagliarelloLongScheid VWW. Human interleukin-1 modulates blood-brain barrier injury in vivo. In: Program and Abstracts of the 27th Interscience Conference on Antimicrobial Agents and Chemotherapy. New York, New York: American Society for Microbiology; 1987 (Abstract 614). Google Scholar15. Tuomanen E. Molecular mechanisms of inflammation in experimental pneumococcal meningitis. Ped Infect Dis J. 1987;6:1146-9. CrossrefGoogle Scholar16. KadurugamuwaHengstlerTuomanenSandeZak JBEMO. Effect of a cycly-oxygenase inhibitor on the course and outcome of experimental meningitis in rabbits. In: Program and Abstracts of the 27th Interscience Conference on Antimicrobial Agents and Chemotherapy. New York, New York: American Society for Microbiology; 1987 (Abstract 619). Google Scholar17. Tomasz A. Mode of action of beta lactam antibiotics: a microbiologist's view. In: Demain A, ed. Handbook of Experimental Pharmacology, 67/I. New York: Springer-Verlag; 1983:15-93. Google Scholar18. TuomanenGilbertTomasz EKA. Modulation of bacteriolysis by cooperative effects of penicillin-binding proteins la and 3 in Escherichia coli. Antimicrob Agents Chemother. 1986;30:659-63. CrossrefMedlineGoogle Scholar19. TureenStellaSachdevaKennedySande JFMSM. Evaluation of anti-pneumococcal monoclonal antibody for treatment of experimental pneumococcal meningitis in rabbits. In: Program and Abstracts of the 27th Interscience Conference on Antimicrobial Agents and Chemotherapy. New York, New York: American Society for Microbiology; 1987 (Abstract 615). Google Scholar20. WrightJong SM. Adhesion-promoting receptors on human macrophages recognize Escherichia coli by binding to lipopolysaccharide. J Exp Med. 1986;164:1876-88. CrossrefMedlineGoogle Scholar21. TuomanenWright ES. Reduction of inflammation in experimental bacterial meningitis by monoclonal antibody against adhesion receptors of leukocytes. In: Program and Abstracts of the 28th Interscience Conference on Antimicrobial Agents and Chemotherapy. New York, New York: American Society for Microbiology; 1988 (Abstract 877). Google Scholar22. SyrogiannopoulosOlsenReischMcCracken GKJG. Dexamethasone in the treatment of experimental Haemophilus influenzae type B meningitis. J Infect Dis. 1987;155:213-9. CrossrefMedlineGoogle Scholar23. LebelChraneMcCracken MDG. Dexamethasone and ceftriaxone therapy of bacterial meningitis in infants and children. In: Program and Abstracts of the 27th Interscience Conference on Antimicrobial Agents and Chemotherapy. New York, New York: American Society for Microbiology; 1987. (Abstract 790). Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Elaine Tuomanen, MD, CMAffiliations: The Rockefeller University New York, New York PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byReprogramming the Host Response in Bacterial Meningitis: How Best To Improve Outcome?Clinical Pharmacology of Nervous System DiseasesRole of cytokines in lipopolysaccharide-induced functional and structural abnormalities of astrocytesExperimentelle Untersuchungen zur Therapie der EndophthalmitisMolecular mechanisms in the compartmentalized inflammatory response presenting as meningococcal meningitis or septic shockInfections of the Central Nervous SystemPneumolysin Induces the Salient Histologic Features of Pneumococcal Infection in the Rat Lung In VivoThe tragedy of Mrs T.Therapy of Bacterial Meningitis: Principles and PracticeMeningites et ventriculites experimentales. Modeles et conclusions pratiques 1 November 1988Volume 109, Issue 9Page: 690-692KeywordsAntibioticsBacteriaBacterial meningitisDeath ratesDrugsHomicideInflammationMeningitisMorbiditySubarachnoid hemorrhage ePublished: 1 December 2008 Issue Published: 1 November 1988 PDF downloadLoading ...