Fig. 1.

Workup in suspected bacterial meningitis

(1) Other contraindications for lumbar puncture (such as manifest coagulation disorders, oral anticoagulation) need to be considered. (2) The beginning of antibiotic therapy plus dexamethasone is to be started within 1 h after arrival of the patient at the emergency department. A delay of more than 3 h should be strictly avoided. In case of any delay of the lumbar puncture, antibiotic therapy and adjunctive dexamethasone should be started before CSF is obtained. (3) Imaging signs that can hint at increased intracranial pressure are e.g. generalized brain oedema, hydrocephalus or space occupying brain abscess