Hospital management of Bacterial Meningitis in adults.

Provisional diagnosis:

Guideline applies if:

Meningococcal meningitis suspected and accompanied by rash OR ?bacterial meningitis lacking any specific features.

Back to main Meningitis page.

Investigations:

• Blood cultures (2 sets prior to antibiotics if possible)
• EDTA blood for meningococcal PCR

• Consider brain imaging before LP       
• CT usually first choice, though may be normal early in encephalitis; especially useful in emergency if                 there are LP contraindications
• MRI is more sensitive in encephalitis, but is not an emergency investigation and should be discussed with a neurologist/radiologist

• Lumbar puncture if not contra-indicated (opening pressure must be documented) for urgent :

• Microscopy, stain and culture (2 sterile universals sent to microbiology)   

• protein (sterile universal sent to clinical chemistry)

• glucose (fluoride/oxalate tube to biochemistry with blood glucose)

• meningococcal, pneumococcal and viral PCRs (sterile universal to microbiology)

• Acute serum for storage

• Throat swab x2

•     bacterial transport medium for meningococcal culture

•     pink viral transport medium for viral investigation

Empirical therapy

Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.

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