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Adult Bacterial Meningitis

Empiric antibiotics, dexamethasone, lumbar puncture, pneumococcus, meningococcus

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Internal Medicine department. Book Appointment →

What is Adult Bacterial Meningitis?

Adult bacterial meningitis is most commonly caused by Streptococcus pneumoniae (50 percent), Neisseria meningitidis (25 percent), Listeria monocytogenes (10 percent in elderly and immunocompromised), and Haemophilus influenzae. Pathogens reach meninges hematogenously, by direct extension from sinusitis or otitis, or via skull base defects.

Classic triad of fever, neck stiffness, and altered mental status occurs in 44 percent. Headache, nausea, photophobia, seizures, and focal deficits add diagnostic value. Meningococcal disease produces characteristic non-blanching petechial or purpuric rash. Kernig and Brudzinski signs have low sensitivity but high specificity.

Lumbar puncture should be performed urgently unless contraindicated by signs of elevated intracranial pressure, focal neurologic deficits, immunocompromise (CT first), or coagulopathy. CSF shows neutrophilic pleocytosis, elevated protein, low glucose, positive Gram stain in 60 to 90 percent. Empiric ceftriaxone 2 grams every 12 hours plus vancomycin and dexamethasone 10 milligrams every 6 hours for 4 days.

Symptoms

High fever with severe headache
Neck stiffness with positive Kernig or Brudzinski
Altered mental status or confusion
Photophobia and nausea or vomiting
Petechial rash in meningococcal disease

Risk Factors

Recent skull trauma or neurosurgery
Immunocompromise and complement deficiency
Sinusitis or otitis media
Asplenia or splenectomy
College dormitory or military barracks living

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • For high fever with severe headache and neck stiffness
  • For altered mental status with fever
  • For petechial rash with fever
  • For seizures with fever in adults
  • Emergency department immediately for suspected meningitis

Treatment Methods

01
Empiric ceftriaxone 2 g every 12 hours
02
Add vancomycin until pneumococcal susceptibility confirmed
03
Ampicillin if Listeria suspected (over 50, immunocompromised)
04
Dexamethasone 10 mg every 6 hours for 4 days
05
Lumbar puncture after CT in high-risk patients
06
Contact tracing and chemoprophylaxis for meningococcus

Which Department to Visit?

You can visit our Enfeksiyon Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Enfeksiyon Hastalıkları Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.