← Diagnosis and Management Guides
Bacterial Meningitis
Key considerations: Bacterial meningitis, HSV encephalitis, Brain abscess
Cannot miss
- Bacterial meningitis
- HSV encephalitis
- Brain abscess
- SAH
Likely diagnoses
- Bacterial meningitis
- Viral meningitis
- Fungal meningitis (immunocompromised)
Red flags
- Altered mental status
- Petechial rash
- Seizures
- Papilledema
- Focal neuro deficits
Workup
- history: Headache, fever, neck stiffness, photophobia, rash, immunocompromised status; exam: Kernig sign, Brudzinski sign, petechiae, neuro exam; labs: Blood cultures, CBC, BMP, coags, procalcitonin; LP: opening pressure, cell count, protein, glucose, Gram stain, culture, HSV PCR; imaging: CT head BEFORE LP if: immunocompromised, history of CNS disease, new seizure, papilledema, focal deficits, AMS; bedside: Do NOT delay antibiotics for imaging
Management
- immediate: Empiric antibiotics IMMEDIATELY: vancomycin + ceftriaxone (+ ampicillin if age >50 for Listeria); Dexamethasone 0.15mg/kg IV q6h x4 days (give with or before first antibiotic dose); general: Do NOT delay antibiotics to obtain CT or LP; Chemoprophylaxis for close contacts if N. meningitidis (rifampin, cipro, or ceftriaxone)
Disposition
- admit: All bacterial meningitis to ICU; discharge: Never acutely with suspected bacterial meningitis; consults: ID, neurology
Clinical pearls
- Dexamethasone reduces mortality in pneumococcal meningitis — must be given with or before antibiotics
- If CT needed, give antibiotics FIRST then scan — delay kills
Source and review
- IDSA Meningitis Guidelines 2017. Last reviewed: 2024-11-01