Therapie der bakteriellen Meningitis

Zusammenfassung

Die eitrige Meningitis ist eine akute, zumeist durch Bakterien verursachte Erkrankung. Seit mehr als 50 Jahren hat die Verfügbarkeit wirkungsvoller antibiotischer Chemotherapeutika nichts daran geändert, dass die Erkrankung noch immer bei mehr als 20 % der Erkrankten im Erwachsenenalter tödlich verläuft. Die Überlebenden leiden häufig an neurologischen oder neuropsychologischen Residualsymptomen. Im Folgenden beziehen wir uns vor allem auf die außerhalb des Krankenhauses erworbene bakterielle Meningitis des Erwachsenen. In Deutschland empfehlen wir für die kalkulierte antibiotische Therapie eine Behandlung mit Ampicillin und einem Drittgenerations-Zephalosporin. Eine Reduktion der Sterblichkeit und der neurologischen Spätschäden durch die Gabe von Dexamethason konnte kürzlich in einer Studie an Erwachsenen demonstriert werden.

Abstract

Usually, purulent meningitis is an acute bacterial disease. For more than fifty years, antibiotic chemotherapy is widely available. However, the course of bacterial meningitis remains lethal in more than 20 % of affected adult patients. Survivors often suffer from neurological and neuropsychological sequelae. The following article provides an overview of the current therapeutical concepts for community acquired bacterial meningitis in adults. For the treatment of purulent meningitis in Germany, we recommend ampicillin and a third-generation cephalosporin as initial antibiotic therapy. A recent study demonstrated a reduction of mortality and neurological sequelae with adjuvant dexamethasone therapy.

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