The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults
Open accessAbstract
Bacterial meningitis and meningococcal sepsis are rare conditions with high case fatality rates. Early recognition and prompt treatment saves lives. In 1999 the British Infection Society produced a consensus statement for the management of immunocompetent adults with meningitis and meningococcal sepsis. Since 1999 there have been many changes. We therefore set out to produce revised guidelines which provide a standardised evidence-based approach to the management of acute community acquired meningitis and meningococcal sepsis in adults. A working party consisting of infectious diseases physicians, neurologists, acute physicians, intensivists, microbiologists, public health experts and patient group representatives was formed. Key questions were identified and the literature reviewed. All recommendations were graded and agreed upon by the working party. The guidelines, which for the first time include viral meningitis, are written in accordance with the AGREE 2 tool and recommendations graded according to the GRADE system. Main changes from the original statement include the indications for pre-hospital antibiotics, timing of the lumbar puncture and the indications for neuroimaging. The list of investigations has been updated and more emphasis is placed on molecular diagnosis. Approaches to both antibiotic and steroid therapy have been revised. Several recommendations have been given regarding the follow-up of patients.
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Current guidelines recommend targeted PCRs in specific situations rather than routine syndromic testing.
“Current guidelines therefore recommend targeted PCRs in specific situations rather than routine syndromic testing (10–14).”
From Optimized use of the FilmArray Meningitis/Encephalitis panel for early discontinuation of antibiotic therapy (2026) · cites this paper as [10]
The Viral meningitis Recommendations advise PCR for specified viruses when viral meningitis is suspected, with testing for other viruses guided by clinical features. The CSF PCR section discusses pathogen-specific PCR and says multiplex tests are being trialled and should be evaluated before use. It does not explicitly recommend against routine syndromic testing. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn our cohort, a targeted PCR approach would have missed 10 (18%) bacterial meningitis cases caused by H. influenzae, S. agalactiae, and E. coli K1.
“In our cohort, such an approach would have missed 10 (18%) bacterial meningitis cases caused by H. influenzae, S. agalactiae, and E. coli K1 (10–14).”
From Optimized use of the FilmArray Meningitis/Encephalitis panel for early discontinuation of antibiotic therapy (2026) · cites this paper as [10]
The CSF PCR section says that 16S PCR may be used when pathogen-specific PCR does not identify an organism, supporting the general limitation of a targeted approach. The guideline does not report the citing authors’ cohort, the 10 (18%) missed cases, or that those cases were caused by the three named organisms; those are presented as the citing authors’ own findings. (LLM, conf=0.78)
Experimental — accuracy not yet measuredCSF microscopy, biochemistry and culture to confirm aetiology and antimicrobial susceptibility of causative pathogens remain the mainstay of diagnosis.
“CSF microscopy, biochemistry and culture to confirm aetiology and antimicrobial susceptibility of causative pathogens remain the mainstay of diagnosis.32”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [32]
In most cases of ABM neuroimaging is not indicated prior to LP and can result in delays to antibiotic therapy and increased mortality.
“In most cases of ABM neuroimaging is not indicated prior to LP and can result in delays to antibiotic therapy and increased mortality.32”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [32]
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References 287 · Cited by 254
Research works printed but not linked: 5
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- Authors
- McGill, F., Heyderman, R. S., Michael, B. D., Defres, S., Beeching, N. J., Borrow, R., Glennie, L., Gaillemin, O., Wyncoll, D., Kaczmarski, E., Nadel, S., Thwaites, G., Cohen, J., Davies, N. W. S., Miller, A., Rhodes, A., Read, R. C., & Solomon, T.
- Affiliations
- University of Liverpool (GB)
- University College London (GB)
- Public Health England (GB)
- Meningitis Research Foundation (GB)
- Salford Royal NHS Foundation Trust (GB)
- Guy's and St Thomas' NHS Foundation Trust (GB)
- St Mary's Hospital (GB)
- University of Oxford (GB)
- Brighton and Sussex Medical School (GB)
- Chelsea and Westminster Hospital NHS Foundation Trust (GB)
- St George’s University Hospitals NHS Foundation Trust (GB)
- University Hospital Southampton NHS Foundation Trust (GB)
- Corresponding author
- McGill, F.
- ORCID
- Venue
- Journal of Infection
- Publisher
- Elsevier BV
- Published
- 2016-04
- Volume
- 72
- Issue
- 4
- Pages
- 405-438
- ISSN
- 0163-4453 (ISSN-L)
- OpenAlex
- W2271625571
- Cited by
- 254
- References
- 287
- Citations by year
- 2026: 10 · 2025: 29 · 2024: 20 · 2023: 14 · 2022: 21 · 2021: 23 · 2020: 53 · 2019: 27 · 2018: 24 · 2017: 22 · 2016: 10
- FWCI
- 28.32
- Type
- journal article
- Language
- en
- Update notices
- erratum (2016-06-01)
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Infection (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (IS-HPU-1112−10117, ACF-2008-07-001, NF-SI-0514-10177, DRF-2010-03-97, DRF-2013-06-168, CL-2014-07-002)
- Meningitis Research Foundation
- Academy of Medical Sciences (SGL015\1016)
- Public Health England
- British Infection Association
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Keywords
- bacterial meningitis, meningococcal sepsis, acute meningitis, immunocompetent adult, viral meningitis, community-acquired meningitis, lumbar puncture timing, neuroimaging, molecular diagnosis, antibiotic therapy, corticosteroid therapy, patient follow-up, diagnosis and management
- MeSH terms
- Adult, Critical Care, United Kingdom, Humans, Meningococcal Infections, Neisseria meningitidis, Spinal Puncture, Meningitis, Bacterial, Sepsis
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