SummaryThe prognosis of patients with bacterial meningitis has not improved substantially during the last three decades. Several factors have been incriminated to explain this poor prognosis.Host defenses in the meningeal space and poor penetration of the antibiotics in the cerebrospinal fluid, as well as partial bioinactivation of the drugs in the cerebrospinal fluid can be cited to explain the severity of these infections. The indications of the antibiotics commonly administered in the treatment of bacterial meningitis, particularly regarding the third generation cephalosporins and the use of topical aminoglycosides are reviewed. Finally, some practical aspects of the therapy of bacterial meningitis are summarized, and guidelines for antimicrobial therapy are proposed.