Meningitis — inflammation of the membranes that surround the brain and spinal cord — can result from different causes, including viruses, bacteria, fungi, and parasites. Certain diseases like cancer and physical injury can also result in meningitis.
Meningitis treatment and prevention options differ depending on the reason for the illness.
In the United States, viruses are the most common cause of meningitis. These cases are generally mild, and patients typically recover in 7 to 10 days with rest, over-the-counter fever reducers or pain medications, and proper fluid intake.
Although there is no cure for viral meningitis, antiviral medications can help a person’s immune system fight the infection. These include:
Acyclovir (Zovirax) is an effective drug for two forms of viral meningitis: herpes simplex meningitis and varicella zoster (shingles) meningitis.
Antiretrovirals are for patients with meningitis caused by HIV; antiretroviral therapy stops the virus from replicating, or making copies of itself.
Ganciclovir (Cytovene) or foscarnet (Foscavir) may help with cytomegalovirus meningitis (CMV meningitis) in people with weakened immune systems.
Bacterial Meningitis Treatment
Bacterial meningitis is relatively rare, accounting for about 8 percent of cases. But it is considered a medical emergency because it sometimes leads to brain damage, seizures, paralysis, or stroke.
Intravenous antibiotics are the standard treatment, administered as quickly as possible, with the specific antibiotic depending on the type of bacteria. Healthcare providers may also prescribe corticosteroids to reduce inflammation for certain forms of meningitis, but especially bacterial.
Types of bacterial meningitis include:
Meningococcal Meningitis This is caused by the Neisseria meningitidis bacteria. Therapy for suspected disease may include a cephalosporin (a class of antibiotics), such as cefotaxime (Claforan) or ceftriaxone (Rocephin).
Depending on the exact microbial makeup of the bacteria, treatment could also involve penicillin or ampicillin.
Pneumococcal Meningitis Pneumococcus, also known as Streptococcus pneumoniae, is a type of bacteria that can result in one of the deadliest types of meningitis, with a fatality rate as high as 50 percent. Among those most at risk are babies and young children under age 2 and adults over 65.
Treatment would typically include one of the following:
penicillin or ampicillin (Amoxil, Moxilin, Sumox, Trimox)
fluoroquinolones (often called quinolones), such as levofloxacin (Levaquin) and moxifloxacin (Avelox)
Group B Streptococcal (GBS) Meningitis Caused by Streptococcus agalactiae bacteria, this is the most common cause of serious infections in newborns and can lead to meningitis, pneumonia, or sepsis. This is why pregnant women are screened for group B strep in their third trimesters.
Penicillin is the usual treatment.
H. Influenzae Meningitis Before widespread vaccination, Haemophilus influenzae type b (Hib) bacteria caused meningitis in 50 to 60 percent of infections.
Despite its name, this illness is not the same as the flu (influenza), which is caused by a virus.
The mortality rate for H. Influenzae Meningitis is 2 to 5 percent, and many who survive (15 to 30 percent) suffer some permanent neurologic damage, such as blindness, deafness, or intellectual disability.
Antibiotic options include:
ceftriaxone (Rocephin) or cefotaxime (Claforan) for more severe infections
Fungal or Parasitic Meningitis Treatment
If meningitis is fungal in nature, treatment typically depends on the fungus type. Medications include:
amphotericin B (Fungizone)
itraconazole (Sporanox)
fluconazole (Diflucan)
posaconazole (Noxafil)
isavuconazole (Cresemba)
voriconazole
Parasitic infections can also lead to meningitis. Treatment for parasitic eosinophilic meningitis focuses on a category of drugs called antinematodes, which includes:
mebendazole (Vermox)
albendazole (Albenza)
thiabendazole (Mintezol)
Vaccines can protect against a number of different forms of meningitis, while certain basic hygiene measures (like thorough hand-washing) can also be an effective form of prevention.
Vaccines for Viral Meningitis
No vaccines are available to protect against nonpolio enteroviruses, by far the most common cause of viral meningitis. But vaccines can prevent other meningitis-causing viruses.
MMR, Varicella, and MMRV Vaccines The MMR vaccine protects against three meningitis-causing viruses — measles, mumps, and rubella. The varicella vaccine protects against chickenpox, which can also cause meningitis. The MMRV vaccine is a combination of the two vaccines.
The CDC recommends MMRV vaccination for all children between 12 months and 12 years old, with the first of two shots given between ages 12 and 15 months, and the second given between ages 4 and 6 years.
Shingles Vaccine The CDC recommends that adults 50 and over get the shingles vaccines (Shingrix), as shingles infection can lead to meningitis; they need two doses, spaced two to six months apart.
Adults 19 and older with weakened immune systems should also get two doses of the shingles vaccine, if necessary getting the second dose one to two months after the first.
Vaccines for Bacterial Meningitis
Meningococcal Vaccines The Centers for Disease Control and Prevention (CDC) recommends vaccination for all preteens and teens.
Vaccines are formulated to protect against specific serotypes (groups of strains) of bacteria, identified by the letters A, B, C, W, and Y.
The CDC recommends that all children ages 11 and 12 receive one of the following:
Menveo (meningococcal groups A, C, Y, W oligosaccharide diphtheria)
MenQuadfi (meningococcal groups A, C, Y, W conjugate vaccine); note that MenQuadfi replaced Menactra in 2022.
The U.S. Food and Drug Administration (FDA) has approved vaccines for N. meningitis group B for people between ages 10 and 25:
Trumenba (meningococcal group B vaccine)
Bexsero (meningococcal group B vaccine)
Penmenvy (meningococcal groups A, B, C, W, and Y vaccine)
Pneumococcal (Pneumonia) Vaccine The CDC recommends pneumococcal (pneumonia) vaccination for children younger than 5 years, adults 50 years or older, and for children and adults at increased risk for pneumococcal disease, including people who have chronic underlying medical conditions that predispose them to serious illness, such as diabetes, heart disease, lung disease, being immune-compromised, or not having a spleen
The United States uses two types of pneumococcal vaccines:
Vaccines are for Hib only or in combinations with other vaccine:
ActHIB
Hiberix
PedvaxHIB
Pentacel
Vaxelis
Because many meningitis-causing germs spread through respiratory fluids, you can protect yourself and prevent transmission to others by following some standard hygiene practices:
Wash your hands. Attentive hand-washing kills germs.
Don’t share drinks or food. You should also avoid sharing utensils, lip balms, and toothbrushes.
Maintain good health. Eat right, exercise, and get adequate rest to maintain a strong immune system.
Cover your mouth. To stop the spread of germs, cover your mouth and nose when sneezing or coughing.
Treatment for meningitis (swelling of the membranes surrounding the brain and spinal cord) varies depending on what’s causing the condition.
Meningitis due to viruses tends to be mild and people generally recover on their own, but bacterial meningitis is considered a medical emergency and typically requires intravenous antibiotics.
Vaccines can help prevent meningitis, while certain simple hygiene measures (like washing your hands regularly) can prevent the spread of meningitis-causing germs.
