Hospital doctors - adults

Management of Suspected Bacterial Meningitis and Meningococcal Septicaemia in Immunocompetent Adults

Management of Suspected Bacterial Meningitis and Meningococcal Septicaemia in Immunocompetent Adults

Algorithm for Hospital Doctors: Second Edition

This protocol is for doctors in Emergency Medicine, General Medicine, Infectious Diseases, Critical Care and Anaesthetics.

Bacterial meningitis and meningococcal septicaemia are important causes of preventable morbidity and mortality in the UK. Potential improvements in the way patients who may have meningitis or septicaemia are identified and managed have been defined for all levels of healthcare. Most adults with bacterial meningitis or meningococcal septicaemia present to clinicians with little experience of these conditions. Early recognition, stabilisation and institution of specific therapeutic measures are crucial to patient outcome.

Meningitis Research Foundation publishes a resource for hospital doctors treating adults with bacterial meningitis and meningococcal septicaemia. Developed by the British Infection Society in collaboration with the Foundation, this management algorithm focuses specifically on minimising delays in diagnosis and administration of antibiotics, appropriate use of monitoring, investigations, critical care facilities and management of the complications of the disease, primarily shock and raised intracranial pressure.

This management algorithm has now been updated as a result of emerging evidence and the latest national recommendations:

  • The role of steroids receives greater emphasis because of mounting evidence of its utility in meningitis and in septicaemia (de Gans 2004, Annane 2004) .
  • Reference is made to the use of activated protein C in sepsis which has been assessed by NICE and recommended for use within its licensed indication (NICE 2004).
  • Glycaemic control in septicaemia is emphasised (van den Berghe 2001).

It is our intention to update the algorithm on a regular basis to accommodate new evidence and new practices as they arise. The algorithm can be obtained as a poster (A2) or leaflet, available free of charge from your local Foundation office or by using our online ordering facility for these and other Foundation resources.

Click on the icon below to view the algorithm:


The basis of the management plan outlined is explained in the Journal of Infection 2003;46:75-77 (R.S. Heyderman, H.P. Lambert, I O'Sullivan, J.M. Stuart, B.L. Taylor, R.A Wall, on behalf of the British Infection Society).

The updated algorithm was also featured in the Journal of Infection 2005;50:373-374 (R.S. Heyderman on behalf of the British Infection Society)

We hope that it will be of practical value in enabling early recognition and management of meningitis and meningococcal septicaemia, facilitating a better outcome for patients.

We are always pleased to receive feedback, which will be used to improve future updated versions of the resource.

Alan Smith
Meningococcal disease
Meningococcal disease at 20

I spent a week in intensive care, which was terrifying in itself.

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