Patient handout

Bacterial meningitis (acute, community-acquired)

PRODUCTION

1. Your condition

This handout is for bacterial meningitis (acute, community-acquired). Your care team identified this based on: fever + headache + neck stiffness (classic triad).

Other reasons your team may use this plan: altered mental status with fever; petechial / purpuric rash (meningococcemia); new seizure with fever.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
dexamethasone	—	—	—	0.15 mg/kg q6h × 4d, before/with first abx (de Gans NEJM 2002; Brouwer Cochrane 2010)
ceftriaxone	—	—	—	2 g IV q12h — IDSA 2004 / ESCMID 2016 standard for pneumococcus / meningococcus / H. influenzae
vancomycin	—	—	—	AUC/MIC targeted; combined with CTX for resistant pneumococci
ampicillin	—	—	—	Listeria coverage when risk factors present
cefepime	—	—	—	Healthcare-associated / device-related per IDSA/AAN 2017
meropenem	—	—	—	Broad-spectrum CNS penetration; alternative for resistant Gram-negatives
acyclovir	—	—	—	Cover HSV encephalitis until PCR returns negative

Plan: Empiric adult bacterial meningitis bundle

3. When to call your provider

Contact your care team if any of the following happen:

New fever / chills / new headache or neck stiffness → ED for recurrent-meningitis workup (IDSA 2004 Tunkel)
New focal neurologic deficit / new seizure / worsening cognition → urgent neurology + imaging (IDSA 2004 Tunkel; ESCMID 2016)
Subacute headache + nausea / vomiting / cognitive decline → suspect late-onset hydrocephalus → urgent imaging + neurosurgery (ESCMID 2016)
Audiology demonstrates moderate-severe hearing loss → ENT + hearing-aid / cochlear-implant evaluation (de Gans NEJM 2002; NICE 2024 NG240)
PHQ-9 ≥15 OR suicidal ideation → mental-health urgent referral (routes to psych.depression.core.v1 / psych.suicidality.ed.core.v1)
Close contact (meningococcal aetiology) develops fever / rash / headache → ED for immediate evaluation (CDC meningococcal guidelines; NICE 2024 NG240)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

GCS <14, focal neurologic deficit, papilledema, new seizure, or immunocompromise (IDSA 2004 Tunkel)
Petechial / purpuric rash (especially trunk/extremities) with fever (NICE 2024 NG240)(life-threatening)
Hypotension on adequate fluids + lactate >2 + bacterial meningitis suspicion (SSC 2021; Sepsis-3 2016)(life-threatening)
Cushing reflex, papilledema, asymmetric pupils, posturing, or imaging signs of raised ICP (IDSA 2004 Tunkel)(life-threatening)
Recent neurosurgery, ventricular shunt, EVD, or intrathecal pump in situ (IDSA/AAN 2017)
Persistent fever, AMS, or no clinical improvement at 48 h on empiric therapy (IDSA 2004 Tunkel)
Empiric dexamethasone + antibiotic NOT administered within 1 h of clinical suspicion of bacterial meningitis OR LP delayed beyond 30 min when not contraindicated (analogous to SSC Hour-1 bundle; Auburtin CCM 2006 PMID 16915106 each-hour-delay mortality in pneumococcal meningitis)
Behaviourally explicit raised-ICP phenotype: bradycardia + hypertension (Cushing reflex) + abnormal / asymmetric pupils + GCS drop ≥2 points OR new posturing OR new seizure with elevated opening pressure (ESCMID 2016; IDSA 2004 Tunkel)(life-threatening)
Bacterial meningitis + septic shock features (hypotension on adequate fluids + lactate >2 + vasopressor requirement; Sepsis-3 Singer JAMA 2016; SSC 2026) — most commonly Waterhouse-Friderichsen with meningococcus, but pneumococcal sepsis can present similarly(life-threatening)

5. Follow-up

Audiology within 4 weeks (sensorineural hearing loss in pneumococcal); neurology if deficits; close-contact prophylaxis for meningococcal (rifampin / cipro / CTX); vaccinate functionally asplenic / complement-deficient

6. Sources

Guideline: IDSA 2004 + IDSA/AAN 2017 (healthcare-associated) + ESCMID 2016 + NICE NG240 (2024) + WHO 2023 + IDSA 2024 community-acquired bacterial meningitis update (referenced; PMID pending verification)