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Bacterial meningitis — SCE Acute Medicine MCQ

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EasySepsis and Infectious EmergenciesBacterial meningitisSCE Acute Medicine

A 43-year-old man presents with fever, headache, photophobia and progressive confusion. Temperature is 39.2°C, GCS is 13 and there is a non-blanching rash on both legs. CT head would take 90 minutes and there are no focal neurological signs or papilloedema. What is the most important immediate action?

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Correct answer: A — Take blood cultures and give intravenous ceftriaxone immediately

Suspected bacterial meningitis or meningococcal disease requires immediate parenteral antibiotics after blood cultures if this does not delay treatment. Lumbar puncture should not delay antibiotics in an acutely unwell patient. Aciclovir may be added if encephalitis is considered but is not adequate for meningococcal sepsis. The pearl is that early antibiotics protect outcome more than perfect pre-treatment CSF sampling.

Reference: NICE NG240