Give IV antibiotics immediately if bacterial meningitis or meningococcal sepsis is suspected; do not wait for the LP or CT. In the community, give IM or IV benzylpenicillin for a non-blanching rash before transfer. Notify public health.
Clinical clues
- Headache, neck stiffness, photophobia, fever
- Non-blanching petechial or purpuric rash: meningococcal sepsis
- Altered consciousness, seizures; in infants, bulging fontanelle
- Add aciclovir if viral encephalitis is suspected
Empirical antibiotics (adults)
- Ceftriaxone 2 g IV twice daily
- Add amoxicillin 2 g IV if listeria risk (over 60, immunosuppressed, pregnant)
- Dexamethasone 10 mg IV four times daily with or just before the first dose
- Community non-blanching rash: benzylpenicillin before transfer
Suspected meningitis
- Headache, neck stiffness, photophobia
- IV ceftriaxone within 1 h
- Dexamethasone with the first dose
Meningococcal sepsis
- Non-blanching rash, shock
- Benzylpenicillin in the community before transfer
- Fluids, senior and critical care
Life-threatening
- Reduced GCS, seizures, septic shock
- Secure airway, resuscitate
- Notify public health, contact prophylaxis
Emergency steps
1
1. ABC and sepsis
Oxygen, fluids, vasopressors if needed. IV antibiotics within 1 hour. Take blood cultures and meningococcal PCR, but do not delay treatment.
Oxygen, fluids, vasopressors if needed. IV antibiotics within 1 hour. Take blood cultures and meningococcal PCR, but do not delay treatment.
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2
2. Dexamethasone
Dexamethasone 10 mg IV four times daily for suspected bacterial meningitis, with or just before the first antibiotic dose. Do not start it late in meningococcal sepsis.
Dexamethasone 10 mg IV four times daily for suspected bacterial meningitis, with or just before the first antibiotic dose. Do not start it late in meningococcal sepsis.
↓
3
3. Investigate
LP when safe (ideally before or within 1 h of antibiotics). CT first only if focal signs, GCS drop, or immunocompromise, but antibiotics still come first.
LP when safe (ideally before or within 1 h of antibiotics). CT first only if focal signs, GCS drop, or immunocompromise, but antibiotics still come first.
↓
4
4. Prevent spread
Notify public health. Single-dose ciprofloxacin prophylaxis for close contacts of meningococcal disease. Droplet isolation until 24 h of treatment.
Notify public health. Single-dose ciprofloxacin prophylaxis for close contacts of meningococcal disease. Droplet isolation until 24 h of treatment.
| Marker | Bacterial / Viral |
|---|---|
| Appearance | Turbid / clear |
| Predominant cell | Neutrophils / lymphocytes |
| CSF:plasma glucose | Low / normal |
| Protein | High / normal or mildly raised |
LP contraindications
- Focal neurology or papilloedema
- Ongoing seizures or reduced GCS
- Shock, or uncorrected coagulopathy
Pitfalls
- Delaying antibiotics to arrange a CT or LP
- Withholding dexamethasone in suspected bacterial meningitis
- Forgetting contact prophylaxis and notification
- Missing encephalitis (add aciclovir)
MedPrep - www.medprep.uk - Educational revision aid only. Not clinical guidance. Doses are adult examples; check the BNF, current guidelines and local policy, and seek senior advice. Nov 2026