Brain & Nervous System Disorders
Brain & Nervous System Disorder Treatments
Meningitis is inflammation/swelling of the meninges (the protective covering surrounding the brain, spinal cord, and spinal fluid). It is usually caused by infection. This is a serious condition that can cause high fever, severe headache, neck pain and stiffness, rash, vomiting, confusion, light sensitivity, seizures, and even death. Prompt medical treatment significantly decreases the risk of death from meningitis. There are several types of meningitis: bacterial meningitis, viral meningitis, fungal meningitis, parasitic meningitis, amoebic meningitis, and non-infectious meningitis. Non-infectious meningitis may be caused by cancer, certain medications, lupus, head injuries, or brain surgeries. The cause is detected by observing the spinal fluid obtained from a spinal tap under a microscope and performing a culture and sensitivity (C&S) test on the fluid. The sample is contained in a lab to see if an organism (bacteria, fungi, etc.) grows. Testing is done on the culture to identify the organism and see what drugs will treat it. Treatment for meningitis depends on the type of meningitis and symptoms. Most cases require hospitalization and medication to control symptoms and treat the infection. Usually, treatment will begin with IV (intravenous) treatment and change to oral medications once the patient has improved and is well enough to be discharged from the hospital.
-Antibiotics/Antibacterial Medications treat bacterial meningitis. They work by either killing bacteria or limiting their growth in the body. There are many drug classes and agents. The choice of antibiotic in bacterial meningitis will depend on the type of bacteria detected by culture and sensitivity testing. Because bacteria need time to grow in the lab and detection may take a few days, you may begin empiric treatment. This means the physician prescribes antibiotics that will treat the most likely causes of bacterial meningitis, then choose the best antibiotic to continue treatment after culture and sensitivity results are reported.
Common antibiotics used to treat meningitis include penicillin, ampicillin, ceftriaxone, cefepime, vancomycin, and gentamycin.
–Antiviral Medications treat viral meningitis. Antibiotics will NOT help treat a case of viral meningitis. Viral meningitis is usually milder and will usually resolve on its own without antiviral treatment. In severe cases, or in meningitis caused by herpes or flu virus, antiviral treatment may be used. Common antiviral medications that may treat viral meningitis include acyclovir, oseltamivir, and zanamivir.
–Antifungal Medications treat fungal meningitis. Meningitis caused by a fungus is rare, and usually only occurs in patients who have a weakened immune system due to other medical conditions (for example- organ transplant, cancer, HIV). Antifungal agents used in treatment of fungal meningitis include amphotericin B, flucytosine, and fluconazole.
–Antiparasitic Medications Meningitis caused by parasites is very rare. It may occur due to accidental ingestion or exposure to a parasite. Treatment with antiparasitic medications is usually not necessary because it will resolve on its own. Two antiparasitic drugs that might be used in some cases are albendazole and ivermectin.
–Amoebic meningitis medications- Meningitis caused by an amoeba is extremely rare, very dangerous and often fatal. People get infected by swimming in infested freshwater and amoeba enter the brain/spinal cord through the nose. Combinations of anti-infective medications have been used to treat this type of infection.
–IV Fluids are used to prevent dehydration in meningitis. These fluids are similar to the blood/fluid that is naturally occurring in the body. Examples include lactated ringers solution (LR), 0.9 % sodium chloride solution (normal saline or NS), and dextrose 5% in water (D5W).
–Pain relievers and fever reducers are used to keep the patient comfortable, and to prevent febrile seizures. Many pain relievers, such as ibuprofen and acetaminophen, also work as fever reducers. Ketorolac, morphine, hydromorphone, hydrocodone/acetaminophen, and meperidine may also be used to treat severe meningitis pain.
–Steroids/corticosteroids, can reduce the pain and inflammation caused by meningitis. They are generally not recommended in infectious (viral, bacterial, etc.) meningitis, but are often used to help treat non-infectious meningitis.
Most side effects of medications used for meningitis are manageable and will resolve once treatment is finished. Sometimes rare and serious side effects could require a change in therapy. The most common side effects of medications for meningitis treatment are listed below:
-Diarrhoea -Tiredness
-Nausea/vomiting -Muscle aches
-Constipation -Headache
-Dizziness -Rash
-Tiredness -Yeast infection (easily treated with antifungal medication)
-Clostridium difficile (c. diff) infection can occur due to antibiotics killing the “good bacteria” in the gut. This can cause severe diarrheal that may be bloody.
-Allergic reactions can be serious and life-threatening. Signs of an allergic reaction include rash, swelling, and trouble breathing, and may be accompanied by nausea and vomiting.
If you have symptoms of meningitis, it is important to seek medical care right away to avoid serious complications. If you are discharged from the hospital on medications, it is important to watch for severe side effects and contact the doctor right away if you experience these. Finish all your prescribed antibiotic/antiviral/antifungal medication.