How is meningitis treated?

Despite the fact that meningitis is a disease that is characterized by a very severe course, but, fortunately, in our time it is curable. However, in order for the body to be able to cope with the disease and recover without consequences, it is necessary to contact and receive medical assistance in time.

At the first manifestations

Approximately 90 percent of patients diagnosed with meningitis in the first two days of illness recover^[1]. Inflammation of the meninges is insidious in that the disease, especially of meningococcal origin, in most cases progresses rapidly. If the disease develops according to a rapid scenario, then the clock counts and there is not a minute to lose. If you notice symptoms of meningitis in yourself or someone close to you, you should immediately seek medical help. Not only the life of the patient, but also his relatives depends on timely hospitalization. It should be remembered that inflammation of the meninges is most often a contagious disease that can be transmitted by airborne droplets or by household means. For this reason, meningitis is treated in infectious diseases clinics.

Approaches to therapy

Meningitis can be caused by various pathogens (viruses, bacteria, fungi, parasites), so the treatment in different cases also differs. For example, with purulent inflammation, antibiotics are always used. For the treatment of viral meningitis, there is no special method, therefore, in such cases, symptomatic therapy is usually resorted to. To get rid of a disease of a fungal nature, special antifungal drugs are used. Only a doctor can determine the type of therapy and draw up an adequate treatment program, having the results of blood, urine and cerebrospinal fluid tests of the patient.

Etiotropic therapy

Etiotropic therapy is the main technique used to treat meningitis. Its task is to destroy the causative agent of the disease with the help of medicines. This method is suitable for the treatment of meningitis of a bacterial nature. By the way, if a disease is suspected (even before the laboratory determination of its type and type), patients are prescribed broad-spectrum antibiotics.

For confirmed bacterial meningitis, therapy may consist of one or more high, medium, or low penetrating antibacterial agents. In most cases, cephalosporin antibiotics (cefotaxime, cefepime, claforan, ceftriaxone, rocephin) are used to treat meningitis caused by the bacteria Streptococcus pneumoniae or Neisseria meningitidis, ampicillin, penicillin, ceftriaxone, cefotaxime, amoxicillin – against the bacteria Haemophilus influenzae type B and Listeria monocytogenes, vancomycin – against strains of Staphylococcus aureus and Streptococcus pneumoniae resistant to penicillin.

Your doctor may also prescribe a number of other antibiotics, such as meropenem, tobramycin, gentamicin, garamycin, amoxiclav, or another newer antibiotic. If meningitis was caused by tubercle bacillus, then drugs such as ethambutol, isoniazid, streptomycin may be useful. To enhance the antibacterial effect, resort to complex treatment with rifampicin and pyrazinamide. Sometimes family members of a person with bacterial meningitis are given ciprofloxacin or rifampicin for prophylaxis.

Свою специфику имеет терапия гнойного менингита у детей. Для лечения новорожденных (младше 4 недель) чаще всего применяют ампициллин, цефотаксим и/или гентамицин (амикацин). Рекомендуемые антибиотики для детей от 4 до 12 недель – ампициллин и цефалоспорины 3 поколения (цефтриаксон, цефотаксим). Детям от 4 месяцев и до 18 лет при бактериальном менингите обычно назначают цефалоспорины 3 поколения или бензилпенициллин.

Продолжительность лечения и дозировки определяет врач в индивидуальном порядке. Антибактериальная терапия может быть противопоказана людям с аллергией, почечной или печеночной недостаточностью, беременным, а детям назначается только в крайних случаях. Например, те же популярные таблетки сумамед запрещены малышам, кормящим матерям и беременным. Противопоказания связаны с побочными эффектами, которые могут возникать на фоне приема антибиотиков. А это анафилактический шок, отек Квинке, токсическое поражение печени, раздражение пищеварительной системы, нарушения функций вестибулярного аппарата, эндотоксиновый шок (реакция Яриша-Герксгеймера), разрушение микрофлоры кишечника. Меж тем, надо понимать, что вылечить менингит без антибиотиков невозможно.

Symptomatic therapy

Antibacterial agents are not used to combat viral diseases. Therefore, for the treatment of patients with meningitis of viral etiology resort to symptomatic therapy. Antibacterial agents are prescribed taking into account the possible combined etiology of inflammation.

There is no specific drug “against the meningitis virus.” As a rule, the treatment program in this case resembles the classic treatment for colds and consists of painkillers, antipyretics, as well as detoxification and rehydration agents.

To treat the disease, different groups of antiviral drugs are used. If the meningitis was caused by the herpes virus, your doctor may prescribe foxavir (foxarnet) or acyclovir.

If the disease developed against the background of influenza, then peramivir, rapivab, Tamiflu, arbidol, or oseltamivir, used to treat influenza, may be useful. Complex treatment using interferon and glucocorticoids is considered a universal combination for the relief of meningitis of viral etiology. In addition, a patient with meningitis is usually prescribed nootropics, barbiturates, B vitamins.

Patients with fungal meningitis are treated with antimycotic agents. As a rule, drugs from the azole group are used, for example, fluconazole, used against diseases caused by the fungus Candida. Depending on the type of pathogen fungus, other antimycotic drugs are also included in the therapy. For example, amphotericin B is the most common treatment for cryptococcal meningitis (caused by the fungus Cryptococcus neoformans), as well as a parasitic-type disease caused by the single-celled parasite Fowler’s disease. Sometimes patients are prescribed the antimicrobial miconazole or the antibacterial rifampin. In some cases, patients with meningitis are advised to take a sedative and anticonvulsant drug (diazepam, phenytoin).

With meningitis of any etiology, suprastin or claritin are usually prescribed to prevent an allergic reaction. As antiemetic drugs – motilium or cerucal. If the onset of the disease is accompanied by a temperature above 39 degrees, use drugs with anti-inflammatory and antipyretic effects (paracetamol, nurofen, diclofenac). To eliminate cerebral edema, diuretics (furosemide, diacarb, urogluk) are used, cytoflavin is prescribed to normalize the cerebrospinal fluid, and patients are advised to drink tenoten or valerian to relieve anxiety and irritability.

Infuzionnaya therapy

Infusion therapy is a course of droppers prescribed to patients with purulent meningitis. This method is used when it is necessary to normalize the water-salt balance, to alleviate the patient’s condition with fever, vomiting. Infusions in children are usually carried out together with diuretics, corticosteroids and antipyretics. Meanwhile, this method requires special care, since it increases the risk of hypervolemia (an increase in blood volume in the vessels).

First aid for purulent meningitis – intravenous drip of glucose (5-10%) with potassium chloride and saline with ascorbic acid. If the patient has high blood pressure and reduced diuresis, HES (hydroethyl starch) of 3 generations is used as a starting solution, and after stabilization of blood pressure and diuresis, glucose-salt solutions are administered intravenously.

The daily volume of intravenous infusions is usually 30-50 ml per kilogram of body weight (provided that this amount does not exceed daily diuresis). If infusion therapy gives a positive result, the solution is administered every 6-8 hours.

Пациентам с отеком головного мозга или повышенным внутричерепным давлением в качестве стартового раствора болюсно вводят маннитол (при необходимости 2-4 раза в сутки). После инфузии – фуросемид, а затем дексаметазон.

The standard maintenance infusion regimen for adults consists of a 1:1 glucose solution and saline solution. Children under one year old are given the same drugs, but in a ratio of 3: 1.

Rehabilitation

После выписки из стационара в течение 3-5 лет (зависимо от тяжести протекания болезни) пациент должен наблюдаться у невролога, строго выполняя его рекомендации. Впервые врачу следует показаться через месяц после выписки, затем через 3 и 6 месяцев. На второй и третий год консультироваться раз в полгода, а затем раз в год. Примерно через полтора-два месяца после завершения острого периода менингита, следует пройти МРТ (особенно важно для детей и подростков).

During the recovery period, it is important to adhere to a sparing protein diet, without fatty and fried foods, and heat-treat fruits and vegetables before eating. An essential moment of effective recovery is physiotherapy exercises under the supervision of a specialist in exercise therapy, so it is useful to take a ticket to a sanatorium for this time.

Лечебная гимнастика необходима для улучшения двигательной функции и работоспособности. Восстановление с помощью физиотерапии состоит из массажей и процедур с использованием аппаратов: электрофорез, электросон, магнитотерапия, магнитно-лазерные процедуры. Эти методики позволяют простимулировать нервные окончания и мышцы, восстановить координацию и двигательные способности. Эрготерапия в постменингитный период необходима для бытовой адаптации пациента. В частности этот комплекс незаменим людям, у которых болезнь прошла с осложнениями. Эрготерапия призвана научить человека жить полноценной жизнью, несмотря на возможные физические ограничения. Когнитивная терапия необходима, если после болезни ухудшились логическое мышление и память пациента.

About home treatment

On the Internet, you can find a variety of ways to treat meningitis at home with folk remedies. In most cases, it is recommended to take natural preparations made from chamomile, mint, poppy, lavender, linden, rosehip, pine needles, and drink herbal teas. Neurologists categorically oppose this method of treating meningitis. Traditional medicine recipes based on medicinal herbs can be used during the recovery period after drug therapy, and then only after consulting your doctor.

It is impossible to cure only by the forces of traditional medicine. The only treatment option that gives a chance of survival is emergency care and an adequate treatment program using antibiotics. This is what made it possible to increase the survival rate of patients with meningitis from 10 percent (before the discovery of antibiotics) to 90-95%^[2] (using antibacterial agents). Don’t risk your life. Remember: only qualified medical assistance will help to avoid sad consequences, and vaccination is the best way to protect against the disease.

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