Vaccination against the most common pathogens that cause bacterial meningitis is recommended. Dexamethasone should be administered to children and adults with suspected bacterial meningitis before or at the time of initiation of antibiotics.
Empiric antibiotics should be directed toward the most likely pathogens and should be adjusted by patient age and risk factors. Treatment should be started promptly in cases where transfer, imaging, or lumbar puncture may slow a definitive diagnosis. Delayed initiation of antibiotics can worsen mortality. Because clinical findings are also unreliable, the diagnosis relies on the examination of cerebrospinal fluid obtained from lumbar puncture. Examination maneuvers such as Kernig sign or Brudzinski sign may not be useful to differentiate bacterial from aseptic meningitis because of variable sensitivity and specificity. Viral meningitis is generally self-limited with a good prognosis. Most cases of aseptic meningitis are viral and require supportive care. Aseptic meningitis is the most common form of meningitis with an annual incidence of 7.6 per 100,000 adults. Mortality remains high despite the introduction of vaccinations for common pathogens that have reduced the incidence of meningitis worldwide.
Bacterial meningitis is a medical emergency that requires prompt recognition and treatment. The etiologies of meningitis range in severity from benign and self-limited to life-threatening with potentially severe morbidity.
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