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Meningeal syndrome: treatment
Medical expert of the article
Last reviewed: 23.04.2024
Treatment of meningeal syndrome
At the pre-hospital stage, it is important to conduct differential diagnosis between primary and secondary meningitis that occurs against the background of local purulent processes in the face, head area. Timely diagnosis, hospitalization of the patient in the profile department can have a decisive influence on the outcome of the disease. For example, the lethality in otognennyh meningitis in cases when treatment was performed conservatively, reaches 25%, whereas as a result of a timely operation, mortality is reduced to 5%.
Treatment of patients with meningitis is carried out in a stationary environment, before transporting the patient, if appropriate, inject analgesics, in the absence of signs of dehydration - diuretics. When suspected of the bacterial nature of meningitis, benzylpenicillin is intramuscularly administered at a dose of 3-4 million units by intramuscular injection, since most bacterial meningitis is caused by a sensitive flora. The results of numerous studies suggest that prehospital antibiotics contribute to a decrease in mortality, however, the data of a systematic review analyzing 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 dependence.
Randomized studies have shown that early administration of dexamethasone (before or during antibiotic use) improves the prognosis for bacterial meningitis, primarily caused by Haemophilus meningitis and Pneumococcus meningitis. The positive effect of the use of glucocorticoids was observed in both children and adults with acute meningitis who do not have severe physical illnesses. 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 heavy patient, with nosocomial infection, violation of the integrity of the dura mater.
Patients with secondary purulent meningitis that appeared against the background of the existing foci of infection are subject to hospitalization in the surgical departments according to the nature of the disease: in case of otogenous (rhinogenic) meningitis - in the ENT department, in odontogenic - in the department of maxillofacial surgery, with meningitis complicating the abscess brain or epidural abscess, into the neurosurgical department.
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