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Bacterial Meningitis — SCE Infectious Diseases MCQ

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ModerateCNS InfectionBacterial MeningitisSCE Infectious Diseases

A 55-year-old man presents with 3 days of severe headache, photophobia, and neck stiffness. Temperature is 39.2°C. CSF shows: WCC 2,100/µL (90% neutrophils), protein 3.2 g/L, glucose 0.8 mmol/L (serum 6.5). Gram stain shows Gram-positive diplococci. What is the most appropriate empirical treatment?

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Correct answer: B — IV Ceftriaxone 2 g BD plus IV Dexamethasone

CSF findings are consistent with bacterial meningitis, and Gram-positive diplococci suggest Streptococcus pneumoniae. IV Ceftriaxone 2 g BD is the empirical treatment of choice for community-acquired bacterial meningitis in immunocompetent adults under 60. Adjunctive IV Dexamethasone (0.15 mg/kg QDS for 4 days) should be given before or with the first dose of antibiotics, as it reduces mortality and neurological sequelae in pneumococcal meningitis. Amoxicillin should be added if Listeria is suspected (age >60, immunocompromised).

Reference: NICE CG102 2010 (updated 2015) – Bacterial meningitis and meningococcal septicaemia; BSAC/BIA 2016 – Meningitis guidelines