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Pharmacology Mentor > Blog > Pharmacology > Neuropharmacology > CNS infections and their treatment
NeuropharmacologyPharmacology

CNS infections and their treatment

Last updated: 2025/10/06 at 12:27 AM
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CNS infections and their treatment
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Table of Contents
I. Types of CNS InfectionsII. DiagnosisIII. Empirical Therapy: Start Immediately (Do NOT delay for imaging in absence of contraindications)A. Bacterial MeningitisB. Viral CNS InfectionsC. Fungal CNS InfectionsD. Brain AbscessIV. Duration of TherapyV. Prevention and AdjunctsVI. Special CasesVII. References

Central nervous system (CNS) infections include a spectrum of diseases such as meningitis, encephalitis, brain abscess, and healthcare-associated ventriculitis/meningitis. These conditions are associated with significant morbidity and mortality, requiring rapid diagnosis and prompt, targeted intervention.


I. Types of CNS Infections

Infection TypeMost Common CausesKey Features/Notes
MeningitisBacterial: S. pneumoniae, N. meningitidis, H. influenzae, L. monocytogenes. Viral: enteroviruses, HSV, VZV, HIVNeck stiffness, photophobia, fever, headache, altered mental status
EncephalitisHSV-1, arboviruses (West Nile, Japanese, Tick-borne), VZV, CMV, EBV, autoimmune, post-infectiousConfusion, seizures, altered consciousness, focal neurological deficits
Brain AbscessStreptococci, S. aureus, anaerobes, Gram-negativesFocal signs, increased intracranial pressure, less meningeal signs
Healthcare-associated ventriculitis/meningitisCoagulase-negative staphylococci, Gram-negativesRelated to shunts, catheters, neurosurgery

II. Diagnosis

  • Clinical assessment: History and physical (fever, neurological signs, travel exposure)
  • Neuroimaging (CT/MRI): BEFORE lumbar puncture (LP) in suspected increased ICP or focal signs
  • Lumbar puncture: Essential for CSF analysis (cell count, protein, glucose, Gram stain/culture, PCR for viral pathogens)
  • Blood cultures
  • Rapid Diagnostics: PCR for HSV, VZV, enteroviruses; galactomannan and β-D-glucan for fungal CNS infections
  • Ancillary labs: CBC, renal/liver function, glucose

III. Empirical Therapy: Start Immediately (Do NOT delay for imaging in absence of contraindications)

A. Bacterial Meningitis

Age Group / Risk FactorsEmpirical AntibioticsNotes
Adults, community-acquiredCeftriaxone + vancomycinAdd ampicillin if >50 years, immunosuppressed: cover L. monocytogenes
Neonates, infantsAmpicillin + gentamicin/cefotaximeCover GBS, E. coli, L. monocytogenes
Immunosuppressed/pregnantAmpicillin + ceftriaxone + vancomycinAdd acyclovir if HSV possible
Shunt/neurosurgical, healthcare-assocMeropenem + vancomycin (± ceftazidime)Cover MRSA, Pseudomonas, ESBL

Adjunctive Dexamethasone: For adults/children with suspected S. pneumoniae meningitis, started with or before first antibiotic dose.


B. Viral CNS Infections

  • Encephalitis (HSV, VZV): High-dose IV acyclovir
  • CMV: IV ganciclovir or foscarnet
  • Supportive care: ICU monitoring, control of seizures, intracranial pressure
  • Autoimmune/post-infectious: Immunomodulatory therapy (steroids, IVIG, plasma exchange) when indicated.

C. Fungal CNS Infections

InfectionFirst-Line AgentsNotes
Cryptococcal meningitisAmphotericin B + flucytosine induction, then fluconazole maintenanceHIV, transplants; prolonged therapy
Candida CNSAmphotericin B ± flucytosine/echinocandinsHigh mortality; remove infected devices
AspergillusVoriconazoleImmunosuppressed hosts

D. Brain Abscess

  • Empiric: Ceftriaxone + metronidazole ± vancomycin
  • Surgery for drainage often required
  • Tailor therapy to microbiology.

IV. Duration of Therapy

Infection TypeTypical Duration
Bacterial Meningitis7–21 days (pathogen-specific)
HSV Encephalitis≥14–21 days
Brain Abscess4–8 weeks post-surgical drainage
Cryptococcal meningitisInduction (2 weeks), consolidation (8 weeks), maintenance (≥6 months)

V. Prevention and Adjuncts

  • Vaccination: Hib, pneumococcus, meningococcus, mumps, measles, VZV vaccines
  • Chemoprophylaxis: Close contacts of meningococcal cases (rifampin, ciprofloxacin, ceftriaxone)
  • Supportive measures: Airway, seizure control, fluid status, ICP management, rehabilitation
  • Monitor for complications: Hearing loss, neurologic sequelae, hydrocephalus

VI. Special Cases

Patient GroupKey Pathogens / Considerations
NeonatesGBS, E. coli, Listeria, HSV
ElderlyS. pneumoniae, L. monocytogenes, Gram-negatives
ImmunocompromisedCMV, HSV, JC virus (PML), fungi
Returning travelersArboviruses (WNV, JEV), malaria, TB

VII. References

  1. Shrestha J. CNS Infections. StatPearls [Internet]. 2023.
  2. WHO guidelines on meningitis diagnosis, treatment and care. Geneva: World Health Organization; 2025 Apr 9.
  3. Dagra A, et al. Encephalitis and Meningitis: Indications for Intervention. JClinical.org. 2023 Apr 25.
  4. Mayo Clinic. Encephalitis—Diagnosis and treatment. 2024 May 15.
  5. Shin SH, Kim KS. Treatment of Bacterial Meningitis: An Update. Expert Opin Pharmacother. 2012 Oct;13(15):2189-206.
  6. Sigfrid L, et al. Clinical guidelines for community-acquired CNS infections in Europe: A systematic review. JAC. 2019 Sep 5.
  7. CDC. Tick-borne encephalitis—Treatment and prevention. 2024 May 13.
  8. Hart CA. Management of bacterial meningitis. J Infect. 1993.
How to cite this page - Vancouver Style
Mentor, Pharmacology. CNS infections and their treatment. Pharmacology Mentor. Available from: https://pharmacologymentor.com/cns-infections-and-their-treatment/. Accessed on November 15, 2025 at 00:18.
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The medical information on this post is for general educational purposes only and is provided by Pharmacology Mentor. While we strive to keep content current and accurate, Pharmacology Mentor makes no representations or warranties, express or implied, regarding the completeness, accuracy, reliability, suitability, or availability of the post, the website, or any information, products, services, or related graphics for any purpose. This content is not a substitute for professional medical advice, diagnosis, or treatment; always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition and never disregard or delay seeking professional advice because of something you have read here. Reliance on any information provided is solely at your own risk.

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TAGGED: Antibiotics, Antifungal medications, Antiparasitic medications, Arboviruses, Aspergillus species, Bacterial meningitis, Brain abscess, Candida species, Central nervous system infections, Corticosteroids, Cryptococcus neoformans, Encephalitis, Enteroviruses, Experimental treatments, Fungal meningitis, Haemophilus influenzae, Herpes simplex virus, Immunoglobulin, JC virus reactivation, Listeria monocytogenes, Mycobacterium tuberculosis, Neisseria meningitidis, Neurosyphilis, Progressive multifocal leukoencephalopathy (PML), Reversing immunosuppression, Streptococcus pneumoniae, Taenia solium, Tuberculous meningitis, Varicella-zoster virus, Viral meningitis

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