Novel and preclinical treatment strategies in pneumococcal meningitis.

Bewersdorf, Jan P; Grandgirard, Denis; Koedel, Uwe; Leib, Stephen (2018). Novel and preclinical treatment strategies in pneumococcal meningitis. Current opinion in infectious diseases, 31(1), pp. 85-92. Lippincott Williams & Wilkins 10.1097/QCO.0000000000000416

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PURPOSE OF REVIEW Pneumococcal meningitis is the most frequent form of bacterial meningitis in Europe and the United States. Although early antimicrobial and adjuvant therapy with dexamethasone have helped to improve disease outcome in adults, mortality and morbidity rates remain unsatisfactorily high, emphasizing the need for additional treatment options. Promising targets for adjuvant therapy have been identified recently and will be the focus of this review. RECENT FINDINGS Brain disease in pneumococcal meningitis is caused by direct bacterial toxicity and excessive meningeal inflammation. Accordingly, promising targets for adjuvant therapy comprise limiting the release of toxic bacterial products and suppressing inflammation in a way that maximally protects against tissue injury without hampering pathogen eradication by antibiotics. Among the agents tested so far in experimental models, complement inhibitors, matrix-metalloproteinase inhibitors, and nonbacteriolytic antibiotics or a combination of the above have the potential to more efficiently protect the brain either alone (e.g., in children and outside the high-income settings) or in addition to adjuvant dexamethasone. Additionally, new protein-based pneumococcal vaccines are being developed that promise to improve disease prevention, namely by addressing the increasing problem of serotype replacement seen with pneumococcal conjugate vaccines. SUMMARY Pneumococcal meningitis remains a life-threatening disease requiring early antibiotic and targeted anti-inflammatory therapy. New adjuvant therapies showed promising results in animal models but need systematic clinical testing.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases

UniBE Contributor:

Grandgirard, Denis and Leib, Stephen

Subjects:

500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health

ISSN:

1473-6527

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Stephen Leib

Date Deposited:

06 Dec 2017 16:47

Last Modified:

23 Oct 2019 21:47

Publisher DOI:

10.1097/QCO.0000000000000416

PubMed ID:

29095719

BORIS DOI:

10.7892/boris.106903

URI:

https://boris.unibe.ch/id/eprint/106903

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