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EDITORIALS: Jonathan Cohen Management of bacterial meningitis in adults BMJ 2003; 326: 996-997 [Full text]

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Treatment of meningitis

Tom H Hughes-Davies   (12 May 2003)

Algorithm for management of bacterial meningitis and meningococcal septicaemia in adults

Linda M Glennie   (14 May 2003)

Treatment of meningitis 12 May 2003
Tom H Hughes-Davies, Retired paediatrician Breamore Marsh Send response to journal: Re: Treatment of meningitis	Over 50 years the mortality from pneumococcal meningitis seems to have risen from 22% to 34%. In the European trial of steroids (1) 50 patients with pneumococcal meningitis were treated conventionally and 17 died. In 1943 the little penicillin available was given to Brigadier Cairns' team (2-4) in Oxford to find the best way of using it on pneumococcal meningitis. Of the first 50 patients 11 died. On intrathecal penicillin all had sterile CSF at 12 hours. They were also given intramuscular penicllin and sulphadiazine. Among 44 patients comparable with the Dutch series 5 (11%) died against 14% of their steroid group. I never had the courage to abandon intrathecal treatment for meningitis and found it highly satisfactory. 1. De Gans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. N. Engl J Med 2002;347:1549-9. 2. Cairns H, Duthie ES, Lewin WS, Smith HV. Pneumoccal meningitis treated with penicillin. Lancet 1944;(i):655-9. 3. Smith HV, Duthie ES, Cairns H. Chemotherapy of pneumococcal meningitis. Lancet 1946;(i):185-93. 4. Smith HV. RSM meeting on penicillin in neurology. Lancet 1947;(i):558 -60. Competing interests:   None declared
Algorithm for management of bacterial meningitis and meningococcal septicaemia in adults 14 May 2003
Linda M Glennie, Head of Research and Medical Information Meningitis Research Foundation, Midland Way, Thornbury, Bristol, BS35 2BS Send response to journal: Re: Algorithm for management of bacterial meningitis and meningococcal septicaemia in adults	The British Infection Society developed this algorithm for Early Management of Suspected Bacterial Meningitis and Meningococcal Septicaemia in Adults in collaboration with the national charity, Meningitis Research Foundation. It was distributed to UK hospitals with a joint letter from our two organisations early this year, and within the UK further copies can be obtained (in A2 or A4 format) free of charge from the Foundation. The algorithm can also be downloaded as a PDF file from www.meningitis.org and www.britishinfectionsociety.org. We hope this will facilitate the use of this resource. Competing interests:   None declared