New diagnostic and therapeutic options in bacterial meningitis in infants and children.

Bacterial meningitis continues to be an important cause of mortality and morbidity in neonates and children through the world. Current strategies to prevention and therapy of bacterial meningitis are compromised by incomplete understanding of the pathogenesis, emergence of antimicrobial resistant microorganisms and lack of simple diagnostic tools in resource-limited settings. Successful prevention and treatment of bacterial meningitis requires the knowledge on epidemiology including prevalence of antimicrobial resistant pathogens, pathogenesis of meningitis, and pharmacokinetics and pharmacodynamics of antimicrobial agents. The introduction of the protein conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae and Neisseria meningitidis has changed the epidemiology of bacterial meningitis. Suspected bacterial meningitis is a medical emergency and requires empiric antimicrobial therapy without delay, but recognition of pathogens with increasing resistance to antimicrobial agents is an important factor in selection of empiric antimicrobial regimen. A more complete knowledge on the pathogenesis of meningitis is likely to help in development of new diagnostic and therapeutic options for infants and children with bacterial meningitis.