Management of bacterial meningitis in adults

The treatment of bacterial meningitis represents one of the success stories of modern medicine, particularly antibiotics. In the pre-antibiotic era bacterial meningitis was almost always fatal, but the prompt use of appropriate antibiotics together with supportive care can undoubtedly reduce the morbidity and the mortality of this condition substantially. And yet just 10 years ago a large study of acute bacterial meningitis in adults found a mortality of 25%.1 Why can't we do better than that?Acute bacterial meningitis tends to present to non-specialist, and often inexperienced, junior doctors. It is not very common—there are about 1000 patients in the United Kingdom each year—and so individual doctors will not see many patients. These are exactly the circumstances in which a management algorithm can help. The British Infection Society has recently published such an algorithm for the initial management of adult patients with presumed bacterial meningitis,2 and which represents an updated version of the evidence based recommendations published by the society four years ago.3 Key to the success of algorithms such as this …