Summary Appropriate antibiotic therapy is almost always available for the treatment of acute bacterial meningitis and with a better understanding of the pathophysiology of meningitis it may be possible to develop adjunct therapy to lessen the morbidity of this disease. The use of corticosteroids appears to promise an improved outcome in patients with acute bacterial meningitis. Newer concerns are evolving antibiotic resistance with the need to institute appropriate antibiotic therapy. The emergence of antibiotic resistance, especially in S. pneumoniae, has required the laboratory to perform additional testing on these isolates to help in the selection of antibiotic therapy. While H. influenzae has all but disappeared as a cause of meningitis, the laboratory must be prepared to isolate and identify any new or unusual causes of this disease. The development of effective vaccines to prevent meningitis caused by S. pneumoniae and N. meningitidis would further reduce the morbidity and long-term neurological sequelae of meningitis and could also lessen the concern about antibiotic resistance of S. pneumoniae.