Potential Hazards of Bactericidal Activity in Cerebrospinal Fluid
Because bactericidal therapy often results in bacteriolysis of the pathogen, treatment can promote the release of biologically active cell-wall products in the cerebrospinal fluid (that is, the lipopolysaccharide of gram-negative bacteria and the teichoic acid and peptidoglycan of streptococci). This release of cell-wall fragments can increase the production of cytokines (interleukin-1, interleukin-6, and tumor necrosis factor α) in cerebrospinal fluid, exacerbating inflammation and further damaging the blood–brain barrier.32-34 However, in recent studies of experimental Escherichia coli meningitis, cerebrospinal fluid bacteriolysis occurred initially after antibiotic therapy, but the amount of bacterial endotoxin ultimately released was much less than that released by bacteria not exposed to antibiotics.35 Therefore, achieving a rapid bactericidal effect in cerebrospinal fluid remains a primary goal of therapy.