Few medical conditions have a clinical course as incalculable and foudroyant as bacterial meningitis. Whereas antibiotic therapy has improved the treatment of most infectious diseases, the mortality of bacterial meningitis has not significantly changed since the introduction of penicillin and the availability of intensive care units. The prerequisites for good outcome are prompt diagnosis and rapid initiation of antibacterial treatment. Therefore, after the initial diagnostic steps (cultures from blood and cerebrospinal fluid), antibiotic treatment has to be administered as soon as possible. In Germany, the recommended initial treatment for community-acquired bacterial meningitis is a combination of a 3rd generation cephalosporin with ampicillin. In industrialized countries, immunosuppressive treatment with dexamethasone initiated prior to antibiotic treatment has become part of the guidelines in order to alleviate the pro-inflammatory storm induced by the disease.