Bacterial Meningitis

Community-acquired bacterial meningitis has a high fatality rate, and survivors may have significant long-term neurologic sequelae, despite appropriate antibiotics. Although cerebral spinal fluid cultures and/or PCR testing are necessary to establish a definitive case of bacterial meningitis, antibiotic administration should never be delayed while waiting to obtain a lumbar puncture. Patients with suspected bacterial meningitis should be started on empiric antibiotics and adjunctive dexamethasone within an hour of presentation, with subsequent regimens targeted toward the identified pathogen. Vaccines are an important tool to minimize the risk of bacterial meningitis, and use should be encouraged by adults at higher risk.