Meningitis – Adults

  • Keep your suspicions high – early signs it may not be clear
  • Sepsis Kills – give antibiotics & fluid early
  • Consider Acyclovir
  • Give Dexamethasone with Antibiotics – it can reduce neurological sequelae
  • Consider indications for CT before LP
  • Get SENIOR support early

Signs & Symptoms

No single feature is diagnostic, (Get senior input)


  • Common; Fever, Vomiting, Lethargy, Irritable, Headache, Muscular/joint pain
  • Less Common; Shivers, Diarrhoea, Abdo pain, Sore throat, Coryza


  • Purpuric rash, stiff neck, Altered mental state, Photophobia, Kernigs sign


  • BloodsBlood Culture, FBCI-Stat (inc glucose), VBG, LFT, CRP, PCR, Clotting
  • Throat swab
  • LP  – performed by medical team
    • Opening pressure
    • Microscopy
    • Culture + PCR
    • Protein, Glucose, Lactate

Indications for CT before LP*

  • Focal neurological signs
  • Papilloedema**/Pupilary changes
  • Continuous or uncontrolled seizures
  • GCS reduced/fluctuating
  • Bradycardia & Hypertension

*to exclude significant swelling/shift predisposing to cerebral herniation post LP.
**inability to view the fundus is not a contraindication to LP, especially if a short durationof symptoms.

Regardless of CT LP should be delayed /avoided in the following situations:

  1. Respiratory or cardiac compromise
  2. Signs of severe sepsis or a rapidly evolving rash
  3. Infection at the site of the LP
  4. Coagulopathy/thrombocytopenia

Treatment – Get IMMEDIATE Senior support

  • Antibiotics
    • Ceftriaxone 2g IV/IO
      • Over 60yrs add Amoxicillin 2g IV
      • Recent foreign travel add Vancomycin
      • Penicillin/Cephalosporin allergy – contact Microbiology Consultant Immediately
  • Dexamethasone [give at same time as antibiotic]
  • Consider Acyclovir 10mg/kg [use ideal body weight – see below]
  • 0.9% NaCl bolus IV/IO
  • Oxygen titrate to need

Weight (kg)Weight (st)AciclovirDexamethasone
406st 4lb400mg6mg
507st 3lb500mg7.5mg
609st 6 lb600mg9mg
8012st 8lb800mg10mg
9014st 2lb900mg10mg
10015st 11lb1000mg10mg
11017st 5lb1100mg10mg

PDF:meningitis adult

PDF:Antibiotic Guidance

Cochrane Review of Steroid use

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