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Bacterial Meningitis — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesBacterial MeningitisRACP Adult Medicine

A 22-year-old man presents with a 5-day history of high fever, headache, neck stiffness, and photophobia. CSF shows WCC 1200 cells/µL (90% neutrophils), protein 2.8 g/L, and glucose 0.8 mmol/L (serum glucose 6.5 mmol/L). Gram stain shows Gram-positive diplococci. What empirical antibiotic regimen is most appropriate in Australia?

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Correct answer: E — Ceftriaxone 2 g IV BD plus dexamethasone

In Australia, Streptococcus pneumoniae remains the most common cause of bacterial meningitis in adults. eTG recommends ceftriaxone 2 g IV BD (or cefotaxime) as empirical therapy. Dexamethasone 10 mg IV should be given before or with the first dose of antibiotics and continued for 4 days, as it reduces mortality and neurological sequelae in pneumococcal meningitis (de Gans trial). Vancomycin is added if penicillin-resistant pneumococcus is suspected.

Reference: eTG – 2025 – Antibiotic Guidelines; IDSA – 2024 – Bacterial Meningitis Guidelines