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Current Guidelines For Management Of Acute Bacterial Meningitis In The Emergency Department
February 2011
Abstract
In this issue of EM Practice Guidelines Update, 3 practice guidelines addressing the diagnosis and management of bacterial meningitis are reviewed. These recommendations focus on the approach to the initial assessment of a patient with suspected bacterial meningitis and the initial therapy, including antibiotics and corticosteroids. There is considerable controversy around these topics, and the guidelines do differ on several points. The reader should also note the guidelines reviewed here address different age groups: National Institute for Health and Clinical Excellence (NICE) addresses children and young people, European Federation of Neurological Societies (EFNS) addresses older children and adults, and Infectious Diseases Society of America (IDSA) addresses all ages.
Bacterial meningitis is a life-threatening neurological and infectious disease emergency. Acute bacterial meningitis (ABM) is one of the top 10 causes of infection-related death worldwide, and many survivors suffer permanent neurologic sequelae.1 Emergency providers must therefore have a considered approach to the patient with possible ABM in order to make the diagnosis and initiate appropriate therapies efficiently and effectively.
Practice Guideline Impact
- Patients strongly suspected of having ABM should receive antibiotics prior to lumbar puncture (LP) if the LP will be delayed for any reason (such as while obtaining a computed tomography [CT] scan).
- Empiric antibiotics for suspected ABM include a third-generation cephalosporin plus vancomycin. In addition, ampicillin should be given in the very young and the elderly.
- While controversial, adjunctive steroids are recommended for older children and adults with suspected Streptococcus pneumoniae meningitis and should be given before or with the first dose of antibiotics, if possible.
Keywords: acute bacterial meningitis, ABM, guidelines, infectious disease, CNS infection
- » Download Full Topic PDF
- » Take CME Test
- » Management Of Bacterial Meningitis And Meningococcal Septicaemia In Children And Young People Younger Than 16 Years In Primary And Secondary Care
- » Practice Guidelines For The Management Of Bacterial Meningitis
- » EFNS Guideline On The Management Of Community-Acquired Bacterial Meningitis: Report Of An EFNS Task Force On Acute Bacterial Meningitis In Older Children And Adults
- » Editorial Comment
- » References
