Rationale for optimal dosing of beta-lactam antibiotics in therapy for bacterial meningitis

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Abstract
This review considers the five major principles governing optimal dosing ofβ-lactam antibiotics in therapy for bacterial meningitis: (1) the entry or passage of antibiotics into CSF, (2) the antimicrobial activity ofβ-lactams within the purulent CSF in vivo, (3) the bactericidal activity within the CSF, (4) the route and mode of drug administration together with the postantibiotic effect, and (5) the duration of therapy. Special attention is paid to the third principle, bactericidal activity within the CSF, employing the model of the newer, third-generation cephalosporins used in the treatment of meningitis caused by gram-negative aerobic bacilli.