Meningitis and encephalitis
Antibiotics and dexamethasone within the hour, when CT must come before LP, reading CSF, Listeria and pneumococcal cover, HSV encephalitis and its mimics, cryptococcal and TB meningitis, and meningococcal contact prophylaxis in Australia.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Bacterial meningitis is an emergency. Blood cultures, then dexamethasone and ceftriaxone within the first hour. Don't wait for CT or LP.
- The classic triad of fever, neck stiffness and altered mental state appears in under half. Almost everyone has at least two of headache, fever, neck stiffness and altered mental state.
- Listeria needs added benzylpenicillin or amoxicillin in older, pregnant, alcohol-dependent or immunosuppressed patients.
Loading the rest of the note…
Finished reading?
Sources
- Therapeutic Guidelines: Antibiotic. Central nervous system infections (meningitis, encephalitis, brain abscess)AU/NZTherapeutic Guidelines Limited (eTG complete), current eTG edition (topic version not verified)
- Invasive Meningococcal Disease: CDNA National Guidelines for Public Health UnitsAU/NZCommunicable Diseases Network Australia, Australian Government Department of Health, current Series of National Guidelines edition (version not verified)
- ESCMID guideline: diagnosis and treatment of acute bacterial meningitis (van de Beek et al., Clin Microbiol Infect 2016;22 Suppl 3:S37-62)European Society of Clinical Microbiology and Infectious Diseases, 2016 (no update found as of November 2026)
- Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management (NG240)National Institute for Health and Care Excellence, 2024
- The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America (Tunkel et al., Clin Infect Dis 2008)Infectious Diseases Society of America, 2008 (archived by IDSA; the 2004 bacterial meningitis guideline is also archived)
- de Gans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002;347:1549-56New England Journal of Medicine, 2002
- Australian Immunisation Handbook: Meningococcal disease and Japanese encephalitis chaptersAU/NZAustralian Technical Advisory Group on Immunisation, Australian Government Department of Health, current online edition (chapter update dates not verified)
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy