Evaluation and Treatment of Acute Meningitis

Immediate Priorities

• The American College of Physicians recommends immediate stabilization of airway, breathing, and circulation, followed by blood cultures and empiric antibiotics within 1 hour of hospital arrival, with lumbar puncture performed urgently unless contraindicated 1
• The Infectious Diseases Society of America suggests documenting Glasgow Coma Scale score immediately upon arrival for prognostic value and to monitor deterioration 1

Diagnostic Approach

• The European Society of Clinical Microbiology and Infectious Diseases recommends performing cranial imaging before LP only if GCS ≤12, focal neurological signs, or severe immunocompromised state are present 1, 5, 6
• The Centers for Disease Control and Prevention state that CSF leukocyte count is the best diagnostic parameter, with an area under the curve of 0.95 5

Empiric Antibiotic Treatment

• The American Academy of Neurology recommends administering antibiotics within 1 hour of hospital arrival, regardless of whether CT or LP has been performed 1, 5
• The Infectious Diseases Society of America suggests using ceftriaxone 2g IV every 12 hours or cefotaxime 2g IV every 6 hours as empiric treatment for adults <60 years 8, 9

Pathogen-Specific Treatment

• The American College of Physicians recommends using penicillin-sensitive regimens for Streptococcus pneumoniae, with a duration of 10-14 days 8, 4
• The European Society of Clinical Microbiology and Infectious Diseases suggests using ceftriaxone 2g IV every 12 hours or cefotaxime 2g IV every 6 hours for Neisseria meningitidis, with a duration of 5 days 8, 9

Supportive Care and Hemodynamic Management

• The Society of Critical Care Medicine recommends keeping patients euvolemic to maintain normal hemodynamic parameters, and not restricting fluids to reduce cerebral edema 3, 4
• The American Heart Association suggests using norepinephrine as the vasopressor of choice, with a target mean arterial pressure ≥65 mmHg 3, 6

Complications and Follow-Up

• The American Academy of Neurology recommends performing hearing assessment during admission, and repeating if initial test abnormal or clinical suspicion develops 6, 4
• The European Society of Clinical Microbiology and Infectious Diseases suggests performing neuropsychological evaluation for patients with cognitive complaints post-discharge 4