management of bacterial meningitis
Last edited 06/2018 and last reviewed 06/2021
Seek expert advice.
Due to the high mortality associated with acute bacterial meningitis, treatment should be started in suspected cases even before the diagnosis can be confirmed.
- empiric antibiotic treatment
- early antibiotic therapy is associated with lower mortality
- ideally should be given after both blood and CSF have been obtained for culture
- if there is a delay in obtaining the sample, antimicrobial therapy should not be withheld, as a delay can result in a higher probability of adverse clinical outcomes
- choice of initial antibiotic therapy should be based on age, local epidemiological patterns of pneumococcal resistance (1,2)
- adjuvant therapy
- dexamethasone
- not recommended – glycerol and therapeutic hypothermia (2)
Supportive therapy with hydration, antipyretics, analgesia, and nutritional support may be required (1).
Management in primary and secondary care - see linked items.
Reference:
- (1) National Institute for Health and Clinical Excellence (NICE) 2017. Bacterial meningitis and meningococcal septicaemia in children
- (2) McGill F et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016;72(4):405-38.
meningitis (management in primary care)