Letters Bacterial meningitis and lumbar puncture

Lumbar puncture in adult bacterial meningitis: time to reconsider guidelines?

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f361 (Published 30 January 2013) Cite this as: BMJ 2013;346:f361
  1. Martin Glimåker, associate professor and senior consultant1,
  2. Lars Lindquist, professor1,
  3. Jan Sjölin, professor2
  4. For the working party of the Swedish Infectious Disease Society for bacterial CNS infections
  1. 1Unit for Infectious Diseases, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, 171 69 Stockholm, Sweden
  2. 2Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
  1. martin.glimaker{at}karolinska.se

Because of concerns about lumbar puncture (LP) induced cerebral herniation, current guidelines recommend cerebral computerised tomography (CT) before LP in adults with suspected acute bacterial meningitis (ABM) and impaired consciousness.1 2 But this risks delaying ABM treatment, despite guideline emphasis on early treatment based on symptoms and median “door to antibiotic” durations of two to four hours in adults.3 4 Rapid treatment …

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