Rationale: Patients admitted with suspected acute bacterial meningitis require immediate medical attention. Rapid diagnosis and treatment are essential to prevent fatal outcomes or long-term complications. International guidelines recommend initiating antibiotics within 30 minutes. Studies have shown that delayed lumbar puncture and antibiotic administration worsen patient prognosis, often due to waiting for a CT scan. CT of the head is not an effective tool for assessing the risk of herniation in acute bacterial meningitis. Lumbar puncture and cerebrospinal fluid analysis remain the most reliable methods for confirming or ruling out the diagnosis.
Imaging before lumbar puncture should only be considered in specific cases, such as suspected expansive intracranial processes, prolonged illness (>3 days), atypical presentation, or signs of cerebral herniation (severe headache, nausea, neurological deficits like altered consciousness or paralysis).
A 2018 Swedish study in Clinical Infectious Diseases comparing Swedish, ESCMID, and IDSA guidelines found significantly lower mortality and fewer complications when following the Swedish recommendations.
References
- Glimåker et al. (2013) Early lumbar puncture in adult bacterial meningitis—rationale for revised guidelines, Scandinavian Journal of Infectious Diseases, 45:9, 657-663, DOI: 10.3109/00365548.2013.799289
- Glimåker et al. (2018) Lumbar puncture performed promptly or after neuroimaging in acute bacterial meningitis: A prospective national cohort study evaluating different guidelines, Clinical Infectious Diseases 2018:66, 321-328
- Costerus et al. (2018) Cranial computed tomography, early lumbar puncture, and clinical deterioration in bacterial meningitis: A nationwide cohort study, Clinical Infectious Diseases 2018:67, 920-926