The treatment of septic meningitis: 1. antibiotic treatment 1. the principle of medication septic meningitis is serious and progresses rapidly, should be treated early with intravenous antibiotics: cerebrospinal fluid bacterial culture positive, should be made drug sensitivity test, in order to choose high fat-soluble low molecular weight antibiotics that can penetrate the blood-brain barrier, so that the level of bactericidal in the cerebrospinal fluid; mixed medication, should pay attention to the mutual antagonism of drugs. 2, the pathogenic bacteria is not clear antibiotic selection adults should be S. pneumoniae, meningococcal bacteria, infants are E. coli, staphylococcus, streptococcus, young children to H. influenzae, S. pneumoniae, meningococcal bacteria. Multiple recurrences are considered due to S. pneumoniae, and trauma should be considered as Pseudomonas aeruginosa infection. (1) S. pneumoniae meningitis The first choice is penicillin G, the dose should be large, generally adults, penicillin G (16-20> million U/d, divided into 4-6 intravenous drips, children (30-60) million U/(kg-d), divided into intravenous drips; ampicillin adults 8-12 g/d, children 0.3-0.4g/(kg-d), divided into 3 -4 times intramuscularly or intravenously. The dosage can be reduced after the improvement of symptoms, the course of treatment for at least 2 weeks, 3-4 weeks in severe cases. In case of allergy or bacterial resistance to penicillin G and ampicillin, some of the third generation cephalosporins that can cross the blood-cerebrospinal fluid barrier and have low toxicity can be used, such as cefotaxime, ceftizoxime, ceftriaxone and ceftazidime. ) and ceftazidime (ceftazidime) at a dose of 50 mg/kg each time, once every 6-8 hours, and ceftriaxone once every 8-12 hours. (2) Haemophilus influenzae meningitis with ampicillin as the drug of choice. Ampicillin 8-12g/d for adults, 0.3-0.4g/(kg-d) for children, divided into 4-6 intravenous injections; for drug-resistant patients, chloramphenicol or third-generation cephalosporins can be used, chloramphenicol 2-4g/d for adults, 100mg/(kg-d) for children, divided into 2 intravenous drips, or the above two drugs together, the course of treatment is not less than l0 days or at least until the fever is reduced. At least 7 days after fever reduction. For those who are allergic to penicillin or should not use chloramphenicol, the new third generation cephalosporins mentioned above can be used. (3) Gram-negative bacillus meningitis Neonatal E. coli meningitis, hospital-acquired E. pneumoniae, E. enterica, E. deformans, Serratia marcescens, Bacillus immobilis and P. aeruginosa meningitis are the main causes. Ampicillin combined with gentamicin or kanamycin intravenously is preferred. Because of the growth of resistance in gram-negative bacilli, it is most appropriate to use new cephalosporins, which can be applied alone. In case of septic meningitis caused by Pseudomonas aeruginosa or other pseudomonas, in addition to piperacillin, if resistant, ceftazidime of new cephalosporins is the only drug available, if necessary, combined with amikacin (butamycin) and other aminoglycoside antibiotics. The dosage of piperacillin is about 15g/d for adults and 80-250mg/(kd-d) for children, divided into 3-4 times by IV or injection. (4) Staphylococcal meningitis Prefer penicillin-resistant synthetic penicillin, such as benzathine (benzathine penicillin, new penicillin II, oxacillin) and cloxacillin (cloxacillin, cloxacillin), the dosage is 12g/d for adults and 150-200mg/(kd-d) for children, administered every 4-6 hours. The dose is 12g/d for adults and 150-200mg/(kd-d) for children, given every 4-6 hours for more than 2 weeks, and then discontinued for 1 to 2 weeks after the disease is stabilized. First-generation cephalosporins such as cefazolin (vanguardin V, cefazolin) and cefaloridine can be used in combination, and if resistant to the above drugs, vancomycin can be used, 2g/d for adults and 40rag/(kd-d) for children, in 2 slow drips. (5) Neonatal meningitis Group B streptococcal meningitis can be treated with ampicillin or penicillin for not less than 14-21 days; Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus meningitis can be treated with cefuroxime sodium (eehlr nailime) for at least 3 weeks or until 2 weeks after the cerebrospinal fluid is sterile, and can also be combined with ampicillin and gentamicin. (6) meningococcal meningitis without comorbidities to penicillin 300,000 u/kg daily intravenously for 7-10 days; step number of children resistant to penicillin can be switched to the second or third generation cephalosporins. (7) The pathogenic bacteria unknown septic meningitis is often first treated with high-dose penicillin G and chloramphenicol combination. At present, the main choice is the third-generation cephalosporins that can quickly achieve effective bactericidal concentration in the patient’s cerebrospinal fluid, including cefotaxime (cefotaxime. cefo-taxime) 200ms/(kg-d) or ceftriaxone (cefixiaxone) 100mg/(kg-d), the efficacy is not satisfactory can be combined with vancomycin ( vancomycin). In the course of treatment, the cerebrospinal fluid examination should not be repeated for children with uncomplicated Haemophilus influenzae, S. meningitidis and Streptococcus pneumoniae meningitis, but only once when clinical symptoms disappear and the course of treatment is nearly completed. The cerebrospinal fluid and cranial fluoroscopy or CT examination. Principles of treatment (1) Early initiation of empirical treatment with antibacterial drugs. Patients with septic meningitis may be treated empirically based on history, concomitant infection, and possible invasive pathways before failure or bacteriological findings or negative bacteriological tests. The treatment plan will be modified after the pathogenic organism is clarified. (2) Select antibacterial drugs that can easily cross the blood-cerebrospinal fluid barrier. (3) Drugs with strong antimicrobial effect and high safety. (4) Combination of drugs. Before the causative agent is clear, it is appropriate to use two antibacterial drugs in combination. (5) If the causative organism is clear, and it is proved that the bacteria are sensitive to an antibacterial drug, there is no need to add another antibacterial drug. (6) the route of administration, it is appropriate to divide intravenous administration, so that the blood concentration in a short period of time to peak, and according to the drug half-life can be divided into drug administration, in order to facilitate the passage of blood a cerebrospinal fluid barrier and achieve the purpose of antibacterial therapy. (7) The course of treatment should be long, according to the pathogenic bacteria to develop a course of treatment, for the symptoms disappear, the temperature returns to normal and has lasted 3-7 days, the CSF is normal and the culture is negative before the drug can be stopped. Treatment of meningitis caused by gram-negative bacilli and Pseudomonas aeruginosa should be extended. (8) Intrathecal injection of drugs should be avoided as much as possible, and can be cautious in special cases. Other symptomatic and supportive treatment 1. The vital signs, consciousness, pupils and blood electrolyte concentration should be closely observed in the first few days of the disease. Pay attention to ensure the water-electrolyte balance. 2. Timely management of hyperthermia, convulsions and infectious shock. 3.Treat the increased intracranial pressure in time to prevent brain herniation. 4, except for meningococcal meningitis, while using antibiotics, intravenous dexamethasone can be injected daily to reduce the promotion of cytokine-regulated inflammatory response by endotoxin produced by rapid sterilization of antibiotics, which is conducive to fever reduction. 5, the treatment of complications. The subdural fluid: a small amount of fluid does not need to be punctured, when the fluid accumulation should be repeatedly punctured and released, usually not more than 20-30 ml each time. most cases can be cured by this treatment; a few cases are subdural pus accumulation, in addition to puncture and release of fluid, according to the pathogenic bacteria need to inject the appropriate antibiotics, if necessary, surgical treatment.