Even today acute purulent meningitis is a life-threatening disease req
uiring immediate diagnosis and therapy. Despite the availability of ba
ctericidal antibiotics, the mortality has not changed within the last
20 years. A therapeutic approach interfering specifically with the pat
hogenesis of inflammation is necessary in order to prevent long-term n
eurological sequelae and death associated with bacterial meningitis. I
n this paper we discuss the present level of understanding of antibiot
ics and adjunctive therapy, especially with regard to the molecular pa
thophysiological events occurring during a CNS infection.