Evaluation of the management of postoperative aseptic meningitis

Clin Infect Dis. 2007 Jun 15;44(12):1555-9. doi: 10.1086/518169. Epub 2007 May 2.


Background: A consensus conference recommended empirical antibiotic therapy for all patients with postoperative meningitis and treatment withdrawal after 48 or 72 h if cerebrospinal fluid culture results are negative. However, this approach is not universally accepted and has not been assessed in clinical trials.

Methods: We performed a cohort study of all patients who received a diagnosis of postoperative meningitis from January 1998 through May 2005 in a teaching hospital. From January 1998 through September 2003 (control period), guidelines were lacking or were not implemented. From October 2003 through May 2005 (interventional period), all patients received a predefined intravenous antibiotic therapy that was discontinued on the third day if the meningitis was considered aseptic. Clinical outcome and duration of antibiotic therapy were analyzed for each patient.

Results: Seventy-five episodes of postoperative meningitis (21 cases of bacterial meningitis and 54 cases of aseptic meningitis) were investigated. Patients with aseptic meningitis received antibiotic treatment for a mean +/- standard deviation duration of 11+/-5 days during the control period and 3.5+/-2 days during the intervention period (P=.001). The duration of antibiotic treatment for bacterial meningitis was not significantly different between the 2 periods. All episodes of bacterial and aseptic meningitis were cured, and complications were rare during both periods.

Conclusions: Stopping antibiotic treatment after 3 days is effective and safe for patients with postoperative meningitis whose cerebrospinal fluid culture results are negative.

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Cohort Studies
  • Drug Administration Schedule
  • Female
  • Humans
  • Male
  • Meningitis, Aseptic / cerebrospinal fluid*
  • Meningitis, Aseptic / drug therapy*
  • Meningitis, Bacterial / drug therapy
  • Middle Aged
  • Neurosurgical Procedures / adverse effects
  • Otorhinolaryngologic Surgical Procedures / adverse effects
  • Postoperative Complications / drug therapy*
  • Practice Guidelines as Topic
  • Retrospective Studies
  • Treatment Outcome


  • Anti-Bacterial Agents