[Current Clinical Management of Bacterial Meningitis].

The recent protocols for the clinical management of bacterial meningitis (BM) is reviewed. BM can present as an acute fulminant disease that progresses rapidly in a few hours or as a subacute infection that progressively worsens during several days. The mortality rate with BM and the frequency of neurologic sequelae among those who survive are high. BM is thus a life-threatening neurological emergency. Early recognition, efficient decision-making, and the rapid institution of therapy can be lifesaving. Empirical therapy should be initiated promptly whenever BM is a significant diagnostic consideration. The Infectious Diseases Society of America (2004) and European Federation of Neurological Societies (2008) reported an initial management approach of BM. The guidelines for the clinical management of BM in Japan were published in 2007, and the revision was published in December 2014. These initial therapeutic management protocols for BM differ for every country. The reasons for the different initial therapeutic management are based on the following strategies. The choice of the specific antimicrobial agents for the initial treatment is based on the current knowledge of the antimicrobial susceptibility patterns of these pathogens in the area. For the initial treatment, the assumption should be that antimicrobial resistance is likely. The choice of an empirical antibiotic in BM may be influenced by a number of factors, including the patient's age, systemic symptoms, and local pattern of bacterial resistance. If there is no epidemiologic evidence in Japan, a committee investigates and collects data in the revised Japanese guidelines 2014 for the clinical management of BM.