title: The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults.
abstract: Bacterial meningitis and meningococcal sepsis are rare conditions with high case fatality rates. Early recognition and prompt treatment saves lives. In 1999 the British Infection Society produced a consensus statement for the management of immunocompetent adults with meningitis and meningococcal sepsis. Since 1999 there have been many changes. We therefore set out to produce revised guidelines which provide a standardised evidence-based approach to the management of acute community acquired meningitis and meningococcal sepsis in adults. A working party consisting of infectious diseases physicians, neurologists, acute physicians, intensivists, microbiologists, public health experts and patient group representatives was formed. Key questions were identified and the literature reviewed. All recommendations were graded and agreed upon by the working party. The guidelines, which for the first time include viral meningitis, are written in accordance with the AGREE 2 tool and recommendations graded according to the GRADE system. Main changes from the original statement include the indications for pre-hospital antibiotics, timing of the lumbar puncture and the indications for neuroimaging. The list of investigations has been updated and more emphasis is placed on molecular diagnosis. Approaches to both antibiotic and steroid therapy have been revised. Several recommendations have been given regarding the follow-up of patients.
authors: Institute of Infection and Global Health, University of Liverpool, UK; National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, UK; Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK; Leeds Teaching Hospitals NHS Trust, UK. Electronic address: fmcgill@liv.ac.uk.
authors: F
authors: F
authors: McGill
authors: Division of Infection & Immunity, University College London, UK.
authors: R S
authors: RS
authors: Heyderman
authors: Institute of Infection and Global Health, University of Liverpool, UK; Walton Centre NHS Foundation Trust, Liverpool, UK.
authors: B D
authors: BD
authors: Michael
authors: Institute of Infection and Global Health, University of Liverpool, UK; Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK; NHS Tayside, UK.
authors: S
authors: S
authors: Defres
authors: Institute of Infection and Global Health, University of Liverpool, UK; National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, UK; Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK; Liverpool School of Tropical Medicine, UK.
authors: N J
authors: NJ
authors: Beeching
authors: Vaccine Evaluation Unit, Public Health England, Manchester, UK.
authors: R
authors: R
authors: Borrow
authors: Meningitis Research Foundation, Bristol, UK.
authors: L
authors: L
authors: Glennie
authors: Salford Royal NHS Foundation Trust, UK.
authors: O
authors: O
authors: Gaillemin
authors: Guy's and St Thomas' NHS Foundation Trust, UK.
authors: D
authors: D
authors: Wyncoll
authors: Public Health England, UK.
authors: E
authors: E
authors: Kaczmarski
authors: St Mary's Hospital, London, UK; Imperial College, London, UK.
authors: S
authors: S
authors: Nadel
authors: Nuffield Department of Medicine, Oxford University, UK; Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.
authors: G
authors: G
authors: Thwaites
authors: Brighton and Sussex Medical School, Brighton, UK.
authors: J
authors: J
authors: Cohen
authors: Chelsea and Westminster Hospital NHS Foundation Trust, UK.
authors: N W S
authors: NW
authors: Davies
authors: Institute of Infection and Global Health, University of Liverpool, UK; North Cumbria University Hospitals NHS Trust, UK.
authors: A
authors: A
authors: Miller
authors: St Georges University Hospitals NHS Foundation Trust, UK.
authors: A
authors: A
authors: Rhodes
authors: Clinical and Experimental Sciences Unit, University of Southampton, UK; University Hospital Southampton NHS Foundation Trust, UK.
authors: R C
authors: RC
authors: Read
authors: Institute of Infection and Global Health, University of Liverpool, UK; National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, UK; Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK; Walton Centre NHS Foundation Trust, Liverpool, UK.
authors: T
authors: T
authors: Solomon
mesh_terms: D000328:Adult; D003422:Critical Care; D006801:Humans; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D008589:Meningococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D009345:Neisseria meningitidis; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D013129:Spinal Puncture; D006113:United Kingdom
keywords: Adults; Guideline; Meningitis; Meningococcal sepsis