Synopsis
Recognise bacterial meningitis without relying on a complete triad, obtain blood and cerebrospinal-fluid evidence safely, and give ceftriaxone, dexamethasone and Listeria cover in the correct sequence.
- The classic fever, neck stiffness and altered-consciousness triad is insensitive; severe headache or cognitive change with fever warrants urgent evaluation.
- Take blood cultures and EDTA blood for meningococcal and pneumococcal PCR before antibiotics only when this causes no delay.
- Give ceftriaxone 2 g intravenously every 12 hours in adults with suspected bacterial meningitis.
Key red flags
Altered consciousness, shock, focal neurology, papilloedema or uncontrolled seizure changes lumbar-puncture safety and requires senior escalation.
Fever, severe headache, neck stiffness, photophobia, vomiting and altered cognition creates a high-probability syndrome even when one feature is absent.
Investigation priorities
Identify bacteria without requiring lumbar puncture safety.
Management branches
Bacterial meningitis is clinically suspected in an adult.
- Use ABCDE, glucose and early senior review; take blood cultures and PCR and start therapy immediately when sampling would delay.
- Give dexamethasone with or immediately before ceftriaxone and add amoxicillin when Listeria risk exists.
The patient is stable enough for lumbar puncture or testing can continue after initial treatment.
Key medicines
Ceftriaxone empirical meningitis treatmentGive ceftriaxone 2 g intravenously every 12 hours in adults with suspected bacterial meningitis.
Dexamethasone adjunctGive dexamethasone 10 mg intravenously every 6 hours for 4 days, starting with or immediately before the first antibiotic.