[Community acquired bacterial meningitis in adults].

Abstract

Bacterial meningitis is a rare but severe disease with a high mortality. The most frequent pathogens in adults are pneumococcus, meningococcus and Listeria. The most important key symptoms are headache, meningism and fever; however, the absence of individual cardinal symptoms does not exclude the diagnosis. The empirical treatment consists of ceftriaxone and ampicillin, supplemented with dexamethasone as needed. It should be initiated without delay if bacterial meningitis is suspected. Before this, two pairs of blood cultures should be obtained followed by a lumbar puncture. An elevated intracranial pressure must be excluded via cerebral computed tomography before performing a lumbar puncture only in patients with confirmation of impaired consciousness, focal neurological deficits or epileptic seizures. In such cases treatment is initiated immediately after obtaining blood cultures but before the lumbar puncture. The identification and management of a focus are essential and should be conducted on the day of admission.