Journal Mobile

MM Raza, RS Heyderman
Journal Issue: 
Volume 36: Issue 3: 2006




Acute  fever  and  headache  is  a  common  clinical  problem  but  clinicians need to remain vigilant with a high index of suspicion for acute bacterial meningitis. Even  when  the  diagnosis  is  suspected  clinically, the  subsequent  investigation  and management is controversial.  We discuss the diagnosis and management of these patients  relevant  to  the  acute  medicine  physician.  The  initial  assessment  should include severity assessment, as appropriate help can then be obtained early.  In the absence of signs of raised ICP, shock, or respiratory failure, a diagnostic LP should be  performed.   If  LP  has  to  be  deferred, CSF  obtained  up  to  48  hours  after antibiotics  have  been  initiated  may  still  lead  to  a  diagnosis  by  PCR.  Where  LP  is contraindicated, or  it  is  anticipated  that  there  will  be  a  delay  of  more  than  30 minutes, a  dose  of  2  g  of  intravenous  cefotaxime  or  ceftriaxone  should  be  given immediately.   Brain  imaging  is  not  indicated  in  the  majority  of  patients.   Early treatment  with  appropriate  antibiotics,  fluid  resuscitation,  and  management  of raised  intracranial  pressure  are  key  to  improving  patient  outcome.   Empirical antibiotic regimens should be guided by the age of the patient and risk factors for resistant pathogens.  Microbiological advice should be sought early if there is any uncertainty. Adjunctive dexamethasone therapy for suspected bacterial meningitis should be administered either before or at the time of antibiotic administration.