Emergency diagnosis and treatment of adult meningitis.
Despite the existence of antibiotic therapies against acute bacterial meningitis, patients with the disease continue to suffer significant morbidity and mortality in both high and low-income countries. Dilemmas exist for emergency medicine and primary-care providers who need to accurately diagnose patients with bacterial meningitis and then rapidly administer antibiotics and adjunctive therapies for this life-threatening disease. Physical examination may not perform well enough to accurately identify patients with meningitis, and traditionally described lumbar puncture results for viral and bacterial disease cannot always predict bacterial meningitis. Results from recent studies have implications for current treatment guidelines for adults with suspected bacterial meningitis, and it is important that physicians who prescribe the initial doses of antibiotics in an emergency setting are aware of guidelines for antibiotics and adjunctive steroids. We present an overview and discussion of key diagnostic and therapeutic decisions in the emergency evaluation and treatment of adults with suspected bacterial meningitis.
Fitch
Michael T
MT
Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. mfitch@wfubmc.edu
van de Beek
Diederik
D
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use; D003907:Dexamethasone; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy*; D011320:Primary Health Care / Q000379:methods*; D013129:Spinal Puncture; D013256:Steroids / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D013256:Steroids; D003907:Dexamethasone