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Antibiotics and steroids are ideally administered within the first 30 minutes after admission when bacterial meningitis is suspected. In case of systemic infection, antibiotics may be administered as soon as the onset of pain and is defined as a level of antibiotics of 5 to 10 mg/kg administered in a single dose for 90 minutes. All other therapy (eg, antiviral therapy) is prescribed according to local regulations. Prognosis The prognosis for a milder bacterial meningitis (ie no pneumonitis, and only mild neurologic sequelae or gastrointestinal symptoms) in a well-trained adult patient is poor. In an elderly patient, the prognosis is poor if pneumonitis occurs before onset of systemic fever and there is delayed onset of pneumonitis. Prevention The American Academy of Pediatrician (AAP) discourages the use of homeopathic drugs. This includes the use of homeopathic medicines for a fever in children (eg, a mixture of one-half to two-thirds of a standard remedy prepared in a dry, well-preserved and tightly sealed package) for the treatment of the illness. In addition, the AAP discourages the use of any antibiotic therapy if pneumonitis occurs before onset of systemic fever, regardless of the patient's age and the time from onset of fever to the next pneumonitis episode. In addition, the AAP discourages the use of aspirin for bacterial meningitis. The AAP believes that aspirin has adverse and sometimes toxic effects in pregnant women, and it also encourages its use in patients with known or suspected infection (including certain surgical procedures). Therefore, it is important to inform patients of the AAP recommendation that all available evidence does not suggest that aspirin causes an increased risk of developing bacterial meningitis in children. Prevention for bacterial meningitis is most effective during the first 21 days following injury or illness, or following any other initial clinical manifestations (eg, headache, fatigue) that are consistent with a bacterial infection (eg, fever, vomiting, and conjunctivitis), followed by a period of at least 6 weeks in which the patient is free from acute symptoms consistent with bacterial meningitis. For the remainder of the course of a bacterial meningitis, the AAP recommends preventive therapy (including prophylactic antifungal therapy). Selected Bibliography Ackerman-Mendel, R.H. (1995). Antibiotics and the risk of secondary bacterial meningitis. Pediatrics, 86(Suppl 2), S1–S18. Anderson, M.O Related Article: