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German guidelines on community-acquired acute bacterial meningitis in adults.
Klein, Matthias; Abdel-Hadi, Carsten; Bühler, Robert; Grabein, Beatrice; Linn, Jennifer; Nau, Roland; Salzberger, Bernd; Schlüter, Dirk; Schwager, Konrad; Tumani, Hayrettin; Weber, Jörg; Pfister, Hans-Walter.
Affiliation
  • Klein M; Department of Neurology, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany. matthias.klein@med.uni-muenchen.de.
  • Abdel-Hadi C; Emergency Department, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany. matthias.klein@med.uni-muenchen.de.
  • Bühler R; , Munich, Germany.
  • Grabein B; Department of Neurology, Bürgerspital, Solothurn, Switzerland.
  • Linn J; Klinische Mikrobiologie und Krankenhaushygiene, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany.
  • Nau R; Department of Diagnostic and Interventional Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.
  • Salzberger B; Department of Neuropathology, Evangelisches Krankenhaus Göttingen-Weende, Georg-August-University, Göttingen, Göttingen, Germany.
  • Schlüter D; Klinik und Poliklinik für Innere Medizin, University of Regensburg, Regensburg, Germany.
  • Schwager K; Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule, Hannover, Germany.
  • Tumani H; Klinik für Hals-Nasen-Ohrenkrankheiten, Kopf- Hals- und plastische Gesichtschirurgie, Kommunikationsstörungen, Fulda, Germany.
  • Weber J; Labor für Liquordiagnostik, Neurologische Universitätsklinik Ulm, University of Ulm, Ulm, Germany.
  • Pfister HW; Department of Neurology, Klinikum Klagenfurt, Klagenfurt, Austria.
Neurol Res Pract ; 5(1): 44, 2023 Aug 31.
Article in En | MEDLINE | ID: mdl-37649122
INTRODUCTION: The incidence of community-acquired acute bacterial meningitis has decreased during the last decades. However, outcome remains poor with a significant proportion of patients not surviving and up to 50% of survivors suffering from long-term sequelae. These guidelines were developed by the Deutsche Gesellschaft für Neurologie (DGN) under guidance of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) to guide physicians through diagnostics and treatment of adult patients with acute bacterial meningitis. RECOMMENDATIONS: The most important recommendations are: (i) In patients with suspected acute bacterial meningitis, we recommend that lumbar cerebrospinal fluid (with simultaneous collection of serum to determine the cerebrospinal fluid-serum glucose index and blood cultures) is obtained immediately after the clinical examination (in the absence of severely impaired consciousness, focal neurological deficits, and/or new epileptic seizures). (ii) Next, we recommend application of dexamethasone and empiric antibiotics intravenously. (iii) The recommended initial empiric antibiotic regimen consists of ampicillin and a group 3a cephalosporin (e.g., ceftriaxone). (iv) In patients with severely impaired consciousness, new onset focal neurological deficits (e.g. hemiparesis) and/or patients with newly occurring epileptic seizures, we recommend that dexamethasone and antibiotics are started immediately after the collection of blood; we further recommend that -if the imaging findings do not indicate otherwise -a lumbar CSF sample is taken directly after imaging. (v) Due to the frequent occurrence of intracranial and systemic complications, we suggest that patients with acute bacterial meningitis are treated at an intensive care unit in the initial phase of the disease. In the case of impaired consciousness, we suggest that this is done at an intensive care unit with experience in the treatment of patients with severe CNS diseases. CONCLUSIONS: The German S2k-guidelines give up to date recommendations for workup, diagnostics and treatment in adult patients with acute bacterial meningitis.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Guideline Language: En Journal: Neurol Res Pract Year: 2023 Document type: Article Affiliation country: Germany Country of publication: United kingdom

Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Guideline Language: En Journal: Neurol Res Pract Year: 2023 Document type: Article Affiliation country: Germany Country of publication: United kingdom