Once the organism is determined, treatment is tailored to it. A repeat spinal tap should be done several days after initiation of treatment. Treatment should be continued for 2 weeks after cerebrospinal fluid is sterile. The mortality and neurological morbidity associated with bacterial meningitis are high.

Herpetic Meningitis
Herpetic meningitis is less common than bacterial meningitis. Seizures are often the first sign of herpetic meningitis. The clinical and cerebrospinal fluid findings associated with herpetic meningitis are similar to those found in bacterial meningitis. The decision to start antiviral therapy is based on finding cerebrospinal fluid parameters similar to those seen in bacterial meningitis but with a negative Gram-stained smear, historical evidence of genital or labial herpes in the mother, or the presence of cutaneous vesicles in the patient. The drug of choice is acyclovir. The recommended dose in patients with normal renal function is 20 mg/kg every 8 hours for neonates over 33 weeks conceptional age and 20 mg/kg every 12 hours for neonates less than 33 weeks conceptional age. Treatment should be continued for 21 days unless the cerebrospinal fluid polymerase chain reaction and culture for herpes are negative, the vesicular fluid evaluation does not reveal herpes simplex, an alternative explanation for the convulsion is present,and there is no evidence of systemic herpes simplex infection. More about... 68

Inborn Errors of Metabolism
Inborn errors of metabolism produce seizures by altering the brain metabolic milieu. The clinical presentation of inborn errors of metabolism is dominated by coma. Seizures in neonates with inborn errors of metabolism may be produced by a metabolic derangement amiable to etiological treatment and therefore may not require the use of antiepileptic drugs. This situation is rare because in most cases the metabolic abnormalities producing seizures can not be readily corrected by etiological treatment. More about... 71