Corticosteroids meningitis

Plumb VJ, Dismukes WE. Chemical meningitis related to intrathecal corticosteroid therapy. South Med J 1977 70(10) 1241-3. 

Drugs are applied to the mucous membranes of the conjunctiva, nasopharynx, and vagina to achieve local effects. On the other hand, the antidiuretic hormone lypressin (Diapid) is given by nasal spray, but the intention is to produce systemic effects. For the treatment of meningeal leukemia, cytosine arabinoside is injected directly into the spinal subarachnoid space. In osteoarthritis, corticosteroids are given by intra-articular injection. 

Blood-brain barrier Treatment of central nervous system infections, such as meningitis, depends on the ability of a drug to penetrate into the cerebrospinal fluid (CSF). The blood-brain barrier (see p. 8) ordinarily excludes many antibiotics. However, inflammation facilitates penetration and allows sufficient levels of many (but not all) antibiotics to enter the CSF. [Note For cure of meningitis, it is important that a bactericidal rather than a bacteriostatic effect is achieved in the CSF. Yet, this is not without its problems, since rapid bacteriolysis in the infected CSF will liberate high concentrations of bacterial cell walls and lipopolysaccharide that can exacerbate the inflammation. This has led to the use of adjunctive (simultaneous administration of) corticosteroids, which diminish the inflammatory process and neurologic sequelae.]... 

The toxin produced by B. anthracis is a major cause of the morbidity associated with the disease. One study suggested corticosteroids as adjunct therapy for inhalational anthrax associated with extensive edema, respiratory failure and meningitis (11,12). 

In addition to antibiotics, dexamethasone has become a commonly used therapy for the treatment of pediatric meningitis. Corticosteroids inhibit the production of both TNF and IL-1. A series of clinical studies assessing the efficacy of corticosteroid therapy for the initial treatment of bacterial meningitis has reported conflicting results. " The majority of trials were conducted on small sample populations, each with different pathogenic bacterial causes and treatment modalities. The findings of several studies have shown significant... 

Some clinicians believe that corticosteroids should be administered to all patients over the age of 2 months with bacterial meningitis, whereas others believe that corticosteriods not only have limited proven benefits but also have negative effects on the treatment of meningitis. Most clinicians recognize the beneficial effects of corticosteroids in meningitis caused by H. influenzae, but the effects of corticosteroid use in S. pneumoniae and N. meningitidis meningitis remain unclear. 

Kennedy WA, Hoyt Ml, McCracken GH Jr. The role of corticosteroid therapy in children with pneumococcal meningitis. Am J Dis Child 1991 145 1374-1378. 

I Corticosteroids. Adjunctive therapy with corticosteroids may be of benefit in some patients with tuberculous meningitis or pericarditis to relieve inflammation and pressure (see Table 110-4). They should be avoided in most other circumstances because they detract from the immune response to TB. 

Aseptic meningitis, encephalitis, or meningoencephalitis requires hospitalization and supportive treatment based on severity. There is no specific drug therapy for LCM. Anti-inflammatory drugs, such as corticosteroids, may be con.sidered under specific circumstances. Altliough studies have shown that ribavirin, a drug used to treat several other viral diseases, is effective against LCMV in vitro, there is no established evidence to support its use for treatment of LCM in humans. 

Fungal infections A case of cryptococ-cal meningitis complicating corticosteroid therapy has been reported (74 ). 

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