Synopsis
Treat suspected bacterial meningitis as a time-critical emergency, obtain microbiology without unsafe delay, add age- and risk-appropriate therapy, and coordinate complications, prophylaxis and follow-up.
- Fever, headache, neck stiffness and altered consciousness form a high-risk combination, but presentations are incomplete and can evolve over hours; absence of one feature cannot safely exclude meningitis.
- Non-blanching petechiae or purpura supports meningococcal disease, yet meningococcal meningitis and sepsis often present before a rash appears and the rash can be subtle on darker skin.
- Take blood cultures and diagnostic blood samples promptly, but administer empirical antibiotics within one hour of hospital arrival and sooner in shock; investigations must not create treatment delay.
Key red flags
Reduced Glasgow Coma Scale, focal deficit, cranial-nerve palsy, repeated seizure or papilloedema suggests complication and influences airway, imaging and lumbar-puncture decisions.
Investigation priorities
Identify the organism when cerebrospinal-fluid culture may later be sterilised.
Management branches
Bacterial meningitis or meningococcal disease is clinically suspected.
- Use an ABCDE approach, obtain intravenous access, treat hypoxia, shock, hypoglycaemia and seizures, and involve senior emergency, medical and critical-care clinicians early.
- Collect blood cultures and time-critical samples immediately if feasible, then give empirical intravenous antibiotics within the emergency standard without waiting for CT or lumbar puncture.
The patient is sufficiently stable and the result will refine diagnosis.
Key medicines
CeftriaxoneNICE recommends 2 g intravenously twice daily for adults with suspected bacterial meningitis while the organism is unknown; verify the current BNF, allergy status and local protocol.
AmoxicillinFor adult Listeria risk, NICE uses 2 g intravenously every 4 hours as an addition to the cephalosporin; adjust through specialist advice where renal function requires it.