When should I consider referring a patient with viral meningitis to secondary care?

Consider referring a patient with viral meningitis to secondary care if they are severely systemically unwell, have suspected complications that cannot be managed in primary care, or if the diagnosis is uncertain. Also refer if the patient is immunocompromised or has untreated HIV infection, especially if there is an inadequate response to initial treatment or new symptoms develop. Urgent referral is advised for pregnant patients at any gestation with suspected viral meningitis. Additionally, if there are signs of raised intracranial pressure, hydrocephalus, or neurological deterioration, urgent specialist assessment is required.

Safety netting advice should be given if the patient is managed in primary care, with instructions to return if symptoms worsen or new symptoms develop.