Document Detail


EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults.
MedLine Citation:
PMID:  18582342     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Acute bacterial meningitis (ABM) is a potentially life-threatening neurological emergency. An agreed protocol for early, evidence-based and effective management of community-acquired ABM is essential for best possible outcome. A literature search of peer-reviewed articles on ABM was used to collect data on the management of ABM in older children and adults. Based on the strength of published evidence, a consensus guideline was developed for initial management, investigations, antibiotics and supportive therapy of community-acquired ABM. Patients with ABM should be rapidly hospitalized and assessed for consideration of lumbar puncture (LP) if clinically safe. Ideally, patients should have fast-track brain imaging before LP, but initiation of antibiotic therapy should not be delayed beyond 3 h after first contact of patient with health service. In every case, blood sample must be sent for culture before initiating antibiotic therapy. Laboratory examination of cerebrospinal fluid is the most definitive investigation for ABM and whenever possible, the choice of antibiotics, and the duration of therapy, should be guided by the microbiological diagnosis. Parenteral therapy with a third-generation cephalosporin is the initial antibiotics of choice in the absence of penicillin allergy and bacterial resistance; amoxicillin should be used in addition if meningitis because of Listeria monocytogenes is suspected. Vancomycin is the preferred antibiotic for penicillin-resistant pneumococcal meningitis. Dexamethasone should be administered both in adults and in children with or shortly before the first dose of antibiotic in suspected cases of Streptococcus pneumoniae and H. Influenzae meningitis. In patients presenting with rapidly evolving petechial skin rash, antibiotic therapy must be initiated immediately on suspicion of Neisseria meningitidis infection with parenteral benzyl penicillin in the absence of known history of penicillin allergy.
Authors:
A Chaudhuri; P Martinez-Martin; P M Martin; P G E Kennedy; R Andrew Seaton; P Portegies; M Bojar; I Steiner;
Publication Detail:
Type:  Journal Article; Practice Guideline    
Journal Detail:
Title:  European journal of neurology : the official journal of the European Federation of Neurological Societies     Volume:  15     ISSN:  1468-1331     ISO Abbreviation:  Eur. J. Neurol.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-27     Completed Date:  2008-08-12     Revised Date:  2008-10-28    
Medline Journal Info:
Nlm Unique ID:  9506311     Medline TA:  Eur J Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  649-59     Citation Subset:  IM    
Affiliation:
Department of Neurology, Essex Centre for Neurological Sciences, Queen' Hospital, Romford, UK. chaudhuria@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Advisory Committees
Child
Community-Acquired Infections / diagnosis*,  therapy*
Humans
Meningitis, Bacterial / diagnosis*,  therapy*
Comments/Corrections
Erratum In:
Eur J Neurol. 2008 Aug;15(8):880
Note: Martin, P M [corrected to Martinez-Martin, P]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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