Treatment Guideline Chart

Acute meningitis is the infection of the subarachnoid space and cerebrospinal fluid by bacteria that may cause local and systemic inflammatory response.
There is the classic triad of symptoms of fever, neck stiffness and altered level of consciousness.
Other symptoms include chills, myalgia, photophobia, severe headache, focal neurologic symptoms, nausea, vomiting, seizures and some patients may present with rash.


Meningitis - Acute, Bacterial References

  1. Attia J, Hatala R, Cook D, et al. Does this adult patient have acute meningitis. J Am Med Assoc. 1999 Jul;282(2):175-181. PMID: 10411200
  2. Marks MI. Bacterial meningitis an update. Clin Pediatr. 1991 Dec;30(12):673-675. PMID: 1764875
  3. Chaudhuri A, Martinez-Martin P, Kennedy PG, et al. 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. Eur J Neurol. 2008 Jul;15(7):649-659. doi: 10.1111/j.1468-1331.2008.02193.x. PMID: 18582342
  4. Pohl CA. Practical approach to bacterial meningitis in childhood. Am Fam Physician. 1993 May;47(7):1595-1603. PMID: 8503345
  5. Raza MW, Shad A, Pedler SJ, et al. Penetration and activity of antibiotics in brain abscess. J Coll Physicians Surg Pak. 2005 Mar;15(3):165-167. PMID: 15808097
  6. Quagliarello VJ, Scheld WM. Treatment of bacterial meningitis. N Engl J Med. 1997 Mar;336(10):708-716. PMID: 9041103
  7. Saez-Llorens X, McCracken Jr G. Bacterial meningitis: antimicrobial and anti-inflammatory treatment of bacterial meningitis. Infect Dis Clin North Am. 1999 Sep;13(3):619-636. PMID: 10470558
  8. Smith L. Comment on the practice guidelines of bacterial meningitis from IDSA. Am Fam Physician. 2005
  9. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004 Nov;39(9):1267-1284. PMID: 15494903
  10. Greenlee JE. Acute bacterial meningitis. Merck Manual; 2013 Mar. Accessed 13 Sep 2013.
  11. Gilbert DN, Moellering RC, Eliopoulos GM, et al. The Sanford Guide to Antimicrobial Therapy. 37th. Sperryville, VA: Antimicrobial Therapy Inc; 2007.
  12. Gunn VL, Nechyba C, eds. The Harriet Lane Handbook: A Manual for Pediatric House Officers. 16th ed. St. Louis, MO: MD Consult LLC; 2002.
  13. Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett’s principles and practice of infectious diseases. 7th ed. Philadelphia: Elsevier Churchill Livingstone, Inc; 2009
  14. Leib SL, Tauber MG. Acute and chronic meningitis. In: Cohen J, Powderly WG, Berkley SF, et al. Cohen and Powderly: Infectious Diseases. 2nd. Edinburgh: Mosby; 2004:251-264.
  15. Prober CG. Central nervous system infections. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 18th. Philadelphia: Saunders, Elsevier; 2007.
  16. Prober CG. Central nervous system infections. In: Kliegman RM, Stanton BF, St Geme JW III, et al, eds. Nelson textbook of Pediatrics. 19th ed. Philadelphia: Saunders, Elsevier; 2011
  17. MedWorm
  18. MedWorm
  19. Ministry of Health Singapore. Clinical practice guidelines: use of antibiotics in adults. MOH (Singapore). Feb 2006.
  20. Kumar A, Gaur AH, Miller ML. Bacterial meningitis. eMedicine.
  21. Centers for Disease Control and Prevention. Guidelines for meningococcal meningitis/septicaemia chemoprophylaxis. CDC. 1997.
  22. Ministry of Health Malaysia. National antibiotic guideline 2014, 2nd edition. Pharmaceutical Services Divisions, Ministry of Health Malaysia. Dec 2014. Accessed 16 Jul 2015.
  23. Tunkel A. Treatment of bacterial meningitis caused by specific pathogens in adults. UpToDate. Jul 2015. Accessed 28 Jul 2015.
  24. Tunkel A. Pathogenesis and pathophysiology of bacterial meningitis. UpToDate. Nov 2014. Accessed 28 Jul 2015.
  25. Meningitis Research Foundation. Meningococcal Meningitis and Septicaemia Guidance Notes. Diagnosis and treatment in general practice. Updated in line with NICE bacterial meningitis and meningococcal septicaemia CG102, SIGN meningococcal disease guideline 102, and NICE feverish illness in children CG160. Meningitis Research Foundation. 2014. Accessed 28 Jul 2015.
  26. Kim DK, Riley LE, Harriman KH, et al. Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older - United States, 2017. MMWR Morb Mortal Wkly Rep. 2017 Feb 10;66(5):136-138. doi: 10.15585/mmwr.mm6605e2. Accessed 17 Mar 2017. PMID: 28182599
  27. Centers for Disease Control and Prevention. Meningococcal vaccine recommendations. CDC. Dec 2016. Accessed 4 May 2017.
  28. van de Beek D, Cabellos C, Dzupova O, et al. European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22(Suppl 3):S37-S62. doi: 10.1016/j.cmi.2016.01.007. Accessed 4 May 2017. PMID: 27062097
  29. Tunkel AR, Hasbun R, Bhimraj A, et al. 2017 Infectious Diseases Society of America's clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis. 2017 Feb. doi: 10.1093/cid/ciw861. PMID: 28203777
  30. Centers for Disease Control and Prevention (CDC). Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2019. CDC. Jan 2019. Accessed 29 May 2019.
  31. Centers for Disease Control and Prevention (CDC). Recommended adult immunization schedule for ages 19 or older, United States, 2019. CDC. Feb 2019.
  32. Patton ME, Stephens D, Moore K, MacNeil JR. Updated recommendations for use of MenB-FHbp serogroup B meningococcal vaccine - Advisory Committee on Immunization Practices, 2016. MMWR Morb Mortal Wkly Rep. 2017 May;66(19):509-513. doi: 10.15585/mmwr.mm6619a6. PMID: 28520709
  33. Tunkel AR. Initial therapy and prognosis of bacterial meningitis in adults. UpToDate. Jan 2019. Accessed 11 Feb 2019.
  34. Tunkel AR. Treatment of bacterial meningitis caused by specific pathogens in adults. UpToDate. Jan 2019. Accessed 11 Feb 2019.
  35. Young N, Thomas M. Meningitis in adults: diagnosis and management. Intern Med J. 2018 Nov;48(11):1294-1307. doi: 10.1111/imj.14102. PMID: 30387309
  36. National Institute for Health and Care Excellence. Epilepsies: the diagnosis and management. NICE. 11 Feb 2020.
  37. Hasbun R. Initial therapy and prognosis of bacterial meningitis in adults. UpToDate. Nov 2019.
  38. Alamarat Z, Hasbun R. Management of acute bacterial meningitis in children. Infect Drug Resist. 2020 Nov;13:4077-4089. doi: 10.2147/IDR.S240162. PMID: 33204125
  39. ClinicalKey. Clinical overview: bacterial meningitis in adults. ClinicalKey. 23 Mar 2021.
  40. ClinicalKey. Clinical overview: bacterial meningitis in children. ClinicalKey. 23 Mar 2021. Accessed 05 May 2021.
  41. Cook AM, Morgan Jones G, Hawryluk GWJ, et al. Guidelines for the acute treatment of cerebral edema in neurocritical care patients. Neurocrit Care. 2020 Jun;32(3):647-666. doi: 10.1007/s12028-020-00959-7. PMID: 32227294
  42. Dyckhoff-Shen S, Koedel U, Pfister HW, et al. SOP: emergency workup in patients w/ suspected acute bacterial meningitis. Neurol Res Pract. 2021 Jan;3(1):2. doi: 10.1186/s42466-020-00098-6. Accessed 05 May 2021. PMID: 33499920
  43. Hasbun R. Clinical features & diagnosis of acute bacterial meningitis in adults. UpToDate. 05 Feb 2021. Accessed 05 May 2021.
  44. Mbaeyi SA, Bozio CH, Duffy J, et al. Meningococcal vaccination: recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep. 2020 Sep;69(9):1-41. doi: 10.15585/mmwr.rr6909a1. PMID: 33417592
  45. Shah PM, Brodt R, Wichelhaus TA, et al. Calculated parenteral initial therapy of bacterial infections: bacterial meningitis. GMS Infect Dis. 2020 Mar;8:Doc07. doi: 10.3205/id000051. PMID: 32373432
  46. Carter E, McGill F. The management of acute meningitis: an update. Clin Med (Lond). 2022 Sep;22(5):396-400. doi: 10.7861/clinmed.2022-cme-meningitis. PMID: 36507811
  47. Fort GG. Meningitis, bacterial. In: Ferri FF. Ferri's Clinical Advisor 2023. Philadelphia, PA: Elsevier Inc; 2023:964-968.e1.
  48. Nath A. Meningitis: bacterial, viral and other. In: Goldman L, Schafer AI. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier Inc; 2023:2442-2458.e2.
  49. World Health Organization (WHO). The immunological basis for immunization series: module 15: meningococcal disease. Update 2020. WHO. 2020.
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