Question

A 46-year-old man presents with fever, confusion, neck stiffness and photophobia. Temperature is 39.4 °C, blood pressure 110/68 mm Hg and heart rate 120 beats/min. You strongly suspect bacterial meningitis. What is the most appropriate next step in management?

Accepted Answer

Administer empiric intravenous antibiotics (and dexamethasone if indicated) immediately after blood cultures, before CT or lumbar puncture

Answer

Await CT head, lumbar puncture and cerebrospinal fluid analysis before starting any antibiotics

Answer

Start oral antibiotics while arranging outpatient lumbar puncture

Answer

Give high-dose corticosteroids alone before starting any antimicrobials

Answer

Delay antibiotics until cerebrospinal fluid Gram stain confirms the organism

Practice question

A 46-year-old man presents with fever, confusion, neck stiffness and photophobia. Temperature is 39.4 °C, blood pressure 110/68 mm Hg and heart rate 120 beats/min. You strongly suspect bacterial meningitis. What is the most appropriate next step in management?