What are the recommended immediate management steps for a patient presenting with suspected bacterial meningitis?

Immediate management steps for suspected bacterial meningitis:

• Arrange emergency transfer to hospital immediately by calling 999; do not delay transfer to give antibiotics unless there is a clinically significant delay in transfer ¹,²,³.
• If a clinically significant delay in transfer is expected, administer a single dose of intravenous or intramuscular ceftriaxone or benzylpenicillin as soon as possible outside hospital ¹,²,³.
• Use ceftriaxone as the preferred antibiotic outside hospital due to its higher activity, but benzylpenicillin is an acceptable alternative if ceftriaxone is unavailable ¹,².
• Do not give antibiotics outside hospital if the patient has a severe allergy to ceftriaxone or benzylpenicillin; in such cases, withhold antibiotics until hospital admission and specialist advice ¹,²,³.
• Administer antibiotic doses according to age and weight as per BNF guidance: for example, benzylpenicillin 1200 mg for adults and children aged 10 years or over, ceftriaxone 80 mg/kg (max 2000 mg) for children 1 month to 11 years, and 2000 mg for older children and adults ¹,².
• Once in hospital, blood cultures and other investigations should be taken before starting intravenous antibiotics, and lumbar puncture performed if safe and without delaying antibiotics ³.
• Start intravenous antibiotics within 1 hour of hospital arrival ³.