Community acquired bacterial meningitis remains a feared infection because of its high morbidity and mortality. During the last decade, the incidence and the microbial resistance patterns of pathogens causing bacterial meningitis have changed considerably. A sharp increase in meningococcal disease has been observed and meningitis caused by penicillin resistant Streptococcus pneumoniae emerged as a matter of major concern. Since pneumococcal resistance in Belgium to third generation cephalosporins remains rare and low level, addition of vancomycin to the initial empirical therapy including third generation cephalosporins is not yet necessary. However, the evolution of the resistance patterns of invasive S. pneumoniae should be followed very carefully. The emergence of penicillin resistant pneumococci also raises concern about the safety of adjuvant anti-inflammatory therapy with dexamethasone. Although there is a growing evidence suggesting a decrease of neurological complications after administration of adjuvant dexamethasone, this therapy may lower the already borderline penetration through the blood-brain barrier of the currently used antibiotics. This may result in therapeutic failure. We therefore presently do not advocate the routine use of dexamethasone in the therapy of adult bacterial meningitis.