The Emergency Management of Adult Bacterial Meningitis

Over the last decade, new protein-conjugate vaccines against Haemophilus influenzae type b (Hib) and Neisseria meningitidis serogroup C (MenC) have had a dramatic effect on the epidemiology of childhood meningitis in the United Kingdom. Amongst adults, bacterial meningitis remains an important cause of preventable morbidity and mortality. Clinicians need to remain vigilant for the possibility of this infection. The identification of the one patient with meningitis out of many with trivial viral infections remains a difficult task. Even once the diagnosis is made clinically, the subsequent investigation and management of the patient remains controversial, with strong opinions often influenced by one or two adverse experiences. Potential improvements in the way we identify and manage meningitis patients have been identified in recent years. This review will focus on those areas relevant to the emergency care specialist. Meningitis in the immunocompromised patient often has a different clinical and epidemiological pattern and is beyond the scope of this review.