Introduction: Are the 1996 SPILF consensus conference recommendations on bacterial meningitis (BM) still adequate?
Objective: The literature published after 1996 was analyzed and the reviewers summarized the available data on antibiotic treatment once BM microbiological diagnosis made or strongly suspected.
Method: A review was made using PubMed, 10,015 references were examined. Only articles published after 1997 were analyzed.
Results: No study allowed to recommend other regimens than those previously recommended in 1996, in case of meningococcal or pneumococcal infection: 3rd generation cephalosporin or amoxicillin, combined with vancomycin in case of penicillin-intermediate or resistant pneumococcus. In some cases, alternatives are possible, in case of pneumococcal infection: meropenem or antipneumococcal fluoroquinolone were recommended by US guidelines. New antibiotics available on the market were tested using experimental pneumococcal meningitis models: daptomycin and ertapenem seemed to be useful but linezolid was not. Among the antibiotic combinations tested, ceftriaxone+rifampicine demonstrated a better efficacy than ceftriaxone+vancomycin. There was not contributive published data on the length of treatment for bacterial meningitis.
Conclusion: No assessed arguments could be found to modify previous guidelines. In case of problem with penicillin-resistant pneumococci, penem or a combination using ceftriaxone and rifampicin may be used.