Short Version: This is an abridged, print version of the guideline. The full version, with complete list of reference and tables, is available at the EJoN website–see Supplementary material. This is a Continuing Medical Education article, and can be found with corresponding questions on the internet at http://www.efns.org/content.php?pid=132. Certificates for correctly answering the questions will be issued by the EFNS.
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
Version of Record online: 10 JUN 2008
© 2008 The Author(s). Journal compilation © 2008 EFNS
European Journal of Neurology
Volume 15, Issue 7, pages 649–659, July 2008
How to Cite
Chaudhuri, A., Martin, P. M., Kennedy, P. G. E., Andrew Seaton, R., Portegies, P., Bojar, M., Steiner, I. and for the EFNS Task Force (2008), 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. European Journal of Neurology, 15: 649–659. doi: 10.1111/j.1468-1331.2008.02193.x
- Issue online: 10 JUN 2008
- Version of Record online: 10 JUN 2008
- Received 13 February 2008 Accepted 29 April 2008
Vol. 15, Issue 8, 880, Version of Record online: 9 JUL 2008
- lumbar puncture;
Acute bacterial meningitis (ABM) is a potentially life-threatening neurological emergency. An agreed protocol for early, evidence-based and effective management of community-acquired ABM is essential for best possible outcome. A literature search of peer-reviewed articles on ABM was used to collect data on the management of ABM in older children and adults. Based on the strength of published evidence, a consensus guideline was developed for initial management, investigations, antibiotics and supportive therapy of community-acquired ABM. Patients with ABM should be rapidly hospitalized and assessed for consideration of lumbar puncture (LP) if clinically safe. Ideally, patients should have fast-track brain imaging before LP, but initiation of antibiotic therapy should not be delayed beyond 3 h after first contact of patient with health service. In every case, blood sample must be sent for culture before initiating antibiotic therapy. Laboratory examination of cerebrospinal fluid is the most definitive investigation for ABM and whenever possible, the choice of antibiotics, and the duration of therapy, should be guided by the microbiological diagnosis. Parenteral therapy with a third-generation cephalosporin is the initial antibiotics of choice in the absence of penicillin allergy and bacterial resistance; amoxicillin should be used in addition if meningitis because of Listeria monocytogenes is suspected. Vancomycin is the preferred antibiotic for penicillin-resistant pneumococcal meningitis. Dexamethasone should be administered both in adults and in children with or shortly before the first dose of antibiotic in suspected cases of Streptococcus pneumoniae and H. Influenzae meningitis. In patients presenting with rapidly evolving petechial skin rash, antibiotic therapy must be initiated immediately on suspicion of Neisseria meningitidis infection with parenteral benzyl penicillin in the absence of known history of penicillin allergy.