[Frequent problems with antibiotic chemotherapy of bacterial CNS diseases. Case reports and recommendations for initial treatment].

The initial antibiotic treatment of bacterial meningoencephalitis has major implications for the course of the disease. The current spectrum of infectious agents must be considered. Antibiotics have to reach sufficient concentrations in the blood and cerebrospinal fluid for a bactericidal action to occur at the site of infection. Frequent problems arising in this condition are: (1) the non-observation of listerial infections, (2) the use of antibiotics not sufficiently active against gram-positive bacteria in pneumococcal meningitis, (3) the development of meningitis following the use of ciprofloxacin in respiratory tract infections, (4) the hasty change in antibiotic regimens in focal parenchymal infections during delayed response to therapy, (5) the use of bacteriostatic antibiotics, and (6) the delay in administering sufficient antibiotic therapy during fulminate meningococcal meningitis. Problems arising from these conditions are illustrated by case reports.