ORIGINAL ARTICLE: PDF OnlySchaad Urs B.Reviews in Medical Microbiology: July 1997 - p 171 Buy Abstract There has undoubtedly been considerable knowledge gained in recent years on the management of bacterial meningitis in childhood. The seven relevant advances are (1) routine early diagnosis, (2) improved intensive care, (3) insights into the pathophysiology, (4) new knowledge of neurotoxicity, (5) availability of potent bactericidal antibiotics, (6) efficient anti-inflammatory therapy, and (7) prevention. The goals of active vaccination and chemoprophylaxis are prevention of disease and limitation of the spread of disease. Since the introduction and widespread use of Haemophilus influenzae type b conjugate vaccines, there has been a marked decline in the incidence of invasive H. influenzae type b disease, especially meningitis. Risk factors associated with poor prognosis include type and number of infecting bacteria, age and immune defence of the patient, severity of disease on admission, and probably, most importantly, the quality of individual management. The mainstays of adequate management are immediate parenteral administration of bactericidal antibiotics, two-day adjunctive dexamethasone therapy commenced before the first antibacterial dose, and, if needed, optimal intensive monitoring and treatment. This review article outlines in detail the relevant antibacterial and anti-inflammatory principles for current management of paediatric patients with bacterial meningitis. © Williams & Wilkins 1997. All Rights Reserved.