Principles of Antimicrobial Therapy for Bacterial Meningitis
The Need for Bactericidal Activity in Cerebrospinal Fluid
Bacterial meningitis is an infection in an area of impaired host resistance. Specific antibody and complement are frequently absent from the cerebrospinal fluid in patients with the disease,20 resulting in inefficient phagocytosis and therefore in rapid bacterial multiplication (to concentrations of 10 million or more colony-forming units per milliliter of cerebrospinal fluid).21 Optimal antibiotic treatment requires that the drug have a bactericidal effect in the cerebrospinal fluid. Patients with pneumococcal and gram-negative bacillary meningitis who are treated with bacteriostatic antibiotics have poor clinical outcomes.22 Similarly, in animals with experimental meningitis, a bactericidal effect is necessary for sterilization of the cerebrospinal fluid and survival