🚑 EmergencyNeurology / InfectiousStudentInternResident

Bacterial Meningitis

Also known as: meningitis · meningococcal disease · CNS infection

A life-threatening infection of the meninges — fever, headache, neck stiffness, photophobia and altered consciousness. Do not delay antibiotics.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

All ages; likely organisms vary by age — neonates (Group B strep, E. coli, Listeria); children/adults (pneumococcus, meningococcus); elderly/immunocompromised/pregnant (add Listeria).

Red flags — escalate / refer

Non-blanching petechial/purpuric rash (meningococcaemia), rapidly falling consciousness, seizures, shock or focal neurology → emergency; give antibiotics immediately.
Signs of raised intracranial pressure → CT before lumbar puncture, but still do not delay antibiotics.

Work-up / diagnosis

1Take blood cultures, then lumbar puncture for CSF (cell count, protein, glucose, Gram stain, culture ± PCR) — but never delay antibiotics for the LP.
2CT head first ONLY if focal signs, seizures, immunocompromise or raised-ICP features.
3Give the first empirical antibiotic dose as early as possible.

Management — overview

Empirical IV antibiotics immediately (do not wait for LP/CT): a third-generation cephalosporin (ceftriaxone or cefotaxime).
Add ampicillin when Listeria is a risk (neonate, age >50, immunocompromised, pregnant).
Give dexamethasone with or just before the first antibiotic dose (reduces complications, especially pneumococcal).
Supportive care: fluids, manage shock/seizures/raised ICP; isolate suspected meningococcal disease.
Notify public health and give close contacts chemoprophylaxis; narrow antibiotics once cultures/sensitivities return.

In-depthFull dosing & advanced protocol

Drug dosing

Ceftriaxone

Empirical first-line

Adult dose: 2 g IV every 12 h (paediatric dose by weight)
Route: Intravenous

Caution: Give within the hour; do not delay for imaging or LP.

ICMRICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) ↗

Dexamethasone

Adjunct (esp. pneumococcal)

Adult dose: 10 mg IV every 6 h, with or before the first antibiotic dose
Route: Intravenous

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Ampicillin (add if Listeria risk)

Neonate / >50 y / immunocompromised / pregnant

Adult dose: High-dose IV per guidance
Route: Intravenous

ICMRICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) ↗

Age-based cover, imaging & contacts

Tailor empirical cover by age and host (add Listeria cover at the extremes of age and in immunosuppression).
CT before LP only for specific features — antibiotics still come first.
Meningococcal contacts: chemoprophylaxis (e.g. rifampicin, ciprofloxacin or ceftriaxone) per public-health guidance; vaccination prevents disease.

ICMRICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

AnaphylaxisAcute, life-threatening systemic hypersensitivity with airway, breathing or circulation compromise within minutes of a trigger. Intramuscular adrenaline is the immediate, life-saving treatment.Snakebite EnvenomationA medical emergency from a venomous snakebite. In India the “Big Four” (cobra, krait, Russell's viper, saw-scaled viper) cause neurotoxic and/or haemotoxic envenomation. Polyvalent anti-snake venom (ASV) is the antidote; many bites are “dry”.Sepsis & Septic ShockLife-threatening organ dysfunction from a dysregulated host response to infection. Early recognition and the “hour-1 bundle” save lives; septic shock adds fluid-refractory hypotension.

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Ceftriaxone

Dexamethasone

Ampicillin (add if Listeria risk)

📈 Age-based cover, imaging & contacts

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Ceftriaxone

Dexamethasone

Ampicillin (add if Listeria risk)

📈 Age-based cover, imaging & contacts

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Age-based cover, imaging & contacts

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Age-based cover, imaging & contacts

References