Key messages

• Patients may present with non-specific features and particularly neonates, infants, postneurosurgical patients, and the elderly.

• Any patient with mental status changes and fever should be assumed to have meningitis and treated as such until the diagnosis is excluded.

• Lumbar puncture may be hazardous in patients with meningococcal septicemia or features of raised intracranial pressure.

• Antibiotic resistance amongst the most common organisms causing meningitis is becoming more common and antibiotic therapy should be adjusted accordingly.

• Adjunctive therapy with anti-inflammatory agents such as steroids has a rational basis for use. Clinical trials have suggested that steroids may be beneficial in community-acquired bacterial meningitis if given before or with the first dose of antibiotics.

• Vaccine research is progressing, so that effective vaccines against all the common causes of bacterial meningitis should be available shortly.

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