Chapter

Therapy of Central Nervous System Infections

Nicholas L. King and Karen L. Roos

in Principles of Drug Therapy in Neurology

Second edition

Published on behalf of Oxford University Press

Published in print September 2010 | ISBN: 9780195146837
Published online April 2013 | e-ISBN: 9780199322961 | DOI: http://dx.doi.org/10.1093/med/9780195146837.003.0879

Series: Contemporary Neurology Series

Therapy of Central Nervous System Infections

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The ability to identify the causative organism of a central nervous system infection (CNS) has been significantly improved over the last several years due to the availability of new molecular diagnostic techniques. The therapy of CNS infections and the prevention and treatment of their neurological complications has not yet benefited from the advances in diagnosis. There are an increasing number of community acquired bacterial organisms that are resistant to antibiotics, therefore the therapy of these infections must be guided by antimicrobial sensitivity testing. Patients that survive bacterial meningitis, herpes encephalitis, fungal, or tuberculous meningitis often have persistent neurological deficits affecting memory, gait and vision. The role of adjunctive agents in the therapy of these infections is being investigated in animal models and clinical trials. The therapy of CNS infections is intermittently interrupted and complicated by the adverse effects of the antimicrobial agents used to eradicate the infection. Antituberculous agents cause hepatotoxicity, peripheral neuropathy, and optic neuritis. Antifungal agents cause nephrotoxicity, hepatotoxicity and bone marrow suppression. When hydrocephalus develops in the course of fungal meningitis requiring the insertion of a ventriculoperitoneal shunt, multiple shunt revisions may be necessary before the patient improves. The current therapeutic recommendations for CNS bacterial, viral, fungal, and parasitic infections will be reviewed, the complications of therapy and controversies discussed, and alternatives to best initial management provided for those patients who cannot tolerate first line therapy or who have resistant organisms.

Chapter.  15031 words.  Illustrated.

Subjects: Neurology

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