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Meningeal syndrome - Treatment
Medical expert of the article
Last reviewed: 04.07.2025
Treatment of meningeal syndrome
At the pre-hospital stage, it is important to conduct differential diagnostics between primary and secondary meningitis arising against the background of local purulent processes in the face and head. Timely diagnosis and hospitalization of the patient in a specialized department can have a decisive impact on the outcome of the disease. For example, mortality in otogenic meningitis in cases where treatment was carried out using conservative methods reaches 25%, while as a result of timely surgery, mortality is reduced to 5%.
Treatment of patients with meningitis is carried out in hospital conditions; before transporting the patient, if there are appropriate indications, analgesics are administered; in the absence of signs of dehydration, diuretics are administered. If the bacterial nature of meningitis is suspected, benzylpenicillin is administered intramuscularly at a dose of 3-4 million U intramuscularly, since most bacterial meningitis is caused by flora sensitive to it. The results of numerous studies indicate that prehospital administration of antibiotics helps reduce mortality; however, the data of a systematic review that analyzed the relationship between the use of antibiotics at the stage of hospitalization and the subsequent course of the disease could not fully confirm the existence of this relationship.
Randomized studies have shown that early administration of dexamethasone (before or simultaneously with antibiotics) improves the prognosis of bacterial meningitis, primarily caused by Haemophilus meningitis and Pneumococcus meningitis. A positive effect of glucocorticoids has been noted in both children and adults with acute meningitis who do not have severe somatic diseases. However, there is no reason to use dexamethasone in patients with meningitis caused by gram-negative flora, as well as in newborns. The use of glucocorticoids is contraindicated in the development of meningitis in a somatically severe patient, in nosocomial infection, or in the presence of a breach in the integrity of the dura mater.
Patients with secondary purulent meningitis that has arisen against the background of an existing source of infection are subject to hospitalization in surgical departments according to the nature of the disease: in the case of otogenic (rhinogenic) meningitis - in the ENT department, in the case of odontogenic meningitis - in the maxillofacial surgery department, in the case of meningitis that complicates the course of a brain abscess or epidural abscess - in the neurosurgical department.
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