Meningitis: antipsychotics to boost antibiotic treatment

Researchers at the Cochin Institute have discovered how to boost the antibiotic treatment against bacterial meningitis: use antipsychotics.

Mostly unknown to the general public, meningitis is an inflammation of the meninges (envelopes of the spinal cord and brain in which the cerebrospinal fluid circulates). There are two forms, the viral, the beggar, and the bacterial, much more serious. If most patients with this form of meningitis cure with antibiotics, when it is not treated, it can cause serious complications (deafness, brain damage, epilepsy, mental disability ...) and in 50% lead to fast and brutal death.

Today, French researchers have found how to strengthen the treatment against this disease. According to their study published in the journal Nature Microbiology, antipsychotic drugs could be widely used to boost the effectiveness of antibiotics already used.

Phenothiazines

Scientists from the Cochin Institute have administered phenothiazines from the antipsychotic family in mice with bacterial meningitis. In a few minutes, the medications deactivated the long sticky arms of the bacteria. Without these appendages, it can no longer move, agglutinate or hang so easily to the blood vessels.

Antipsychotics "reduce the meningococcal colonization of human vessels and prevent vascular dysfunction, intravascular coagulation and overwhelming inflammation that characterize invasive meningococcal disease, and reduce lethality," the authors of the study said. Moreover, "if given at the beginning of infection, it reduces vascular lesions and improves the survival rate of mice that have not received antibiotic treatment."

Few side effects, say the researchers

In detail, antipsychotics weaken the infection but do not kill it. This is where antibiotics still have a role to play: if conventional antibiotics are used with antipsychotics, their effectiveness will be much better, says the study. Thus, antipsychotics could disrupt the existing clusters of the bacteria in humans and antibiotics will then be responsible for killing the infection.

As for those who would be worried about possible dependence or other antipsychotics, "it is therapeutically safe with few side effects when used in moderation. these drugs are used, "say the authors. If new trials are yet to take place, researchers in Cochin are hopeful that their discoveries can lead to more effective treatment in humans.

To be able to diagnose meningitis correctly and on time, a real challenge

In about 70% of cases, bacterial meningitis occurs in infancy, before the age of 5 years. In adults, it is triggered in people who have been in contact with a patient, having a neurosurgical history or being immunocompromised (diabetes, alcoholism, HIV ...) according to the World Health Organization (WHO).

Generally, the patient suffers from high fever, delusions, migraines and vomiting. One of the most serious forms of bacterial meningitis is meningococcal sepsis. The latter is characterized by a haemorrhagic rash and rapid circulatory collapse. Even when diagnosed early and adequate treatment is initiated, 8 to 15% of patients die, often within 24 to 48 hours of onset of symptoms. And if left untreated, meningococcal meningitis is fatal in 50% of cases. It can also cause brain damage, hearing loss or disability in 10 to 20% of survivors.

But whether it is bacterial or viral, the dangerousness of meningitis is due to the fact that it is often misdiagnosed or too late. According to a British study conducted last summer, in 1000 patients followed, in 43% of cases, the virus or the bacteria responsible for the disease had not been identified. However, according to the researchers, "the rapid diagnosis of a specific cause of meningitis is essential to prescribe the right antibiotics if necessary, or to avoid unnecessary antibiotics in patients with viral meningitis." Efforts should focus on treatment symptoms and accelerate the discharge of the hospital, which would be less painful for patients.

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