Intended for healthcare professionals

Rapid response to:


Guidelines for managing acute bacterial meningitis

BMJ 2000; 320 doi: (Published 13 May 2000) Cite this as: BMJ 2000;320:1290

Rapid Response:

preadmission antibiotics


I would like to agree with and to stress the point that preadmission
antibiotics may make it harder to get a microbial diagnosis. Wherever
possible, rapid admission to hospital should be arranged where a lumbar
puncture should be performed immediately, provided there are no focal
neurological signs. Given the latter, cerebral computed tomography
including additional imaging of the skull and the pars petrosa ossis
temporalis should be performed prior to lumbar puncture, provided this
does not cause an unacceptable delay. As soon as csf and blood cultures
are obtained, empirical antibiotic treatment should be started which can
be adapted to the causative germ when a microbial diagnosis has been made.

Competing interests: No competing interests

12 May 2000
Oliver Czech
senior house officer, neurology
Berlin, Germany