What are the recommended immediate management steps for a patient pres

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

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 ,,.
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 ,,.
Use ceftriaxone as the preferred antibiotic outside hospital due to its higher activity, but benzylpenicillin is an acceptable alternative if ceftriaxone is unavailable ,.
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 ,,.
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 ,.
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 .
Start intravenous antibiotics within 1 hour of hospital arrival .

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