Meningitis: Management

Key points

• Transfer ALL patients to hospital urgently. In the community, if meningococcal disease is suspected (e.g. a non-blanching rash), give IM/IV benzylpenicillin if it does not delay transfer.
• Investigations (NICE): FBC, CRP, coagulation screen, blood culture, whole-blood meningococcal/pneumococcal PCR, blood glucose and blood gas; lumbar puncture unless contraindicated (raised ICP signs, shock, coagulopathy). Test all adults for HIV.
• Empirical antibiotics (NG240, 2024): CEFTRIAXONE is first-line while the organism is unknown. Add amoxicillin (Listeria cover) if under 3 months, over 50 years, immunocompromised or pregnant.
• Give IV DEXAMETHASONE (10 mg 6-hourly) to patients over 3 months with suspected or confirmed bacterial meningitis, ideally with or before the first antibiotic dose — it reduces neurological sequelae, especially in pneumococcal meningitis.
• Confirmed meningococcal disease → benzylpenicillin or ceftriaxone/cefotaxime. Arrange household/close-contact prophylaxis (usually ciprofloxacin) via public health.

Decision points in this pathway

• Signs of raised intracranial pressure?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.