Precautions for a College Student Suspected of Having Meningitis
Immediately initiate empiric antibiotic therapy without delay—time to antibiotics is a critical independent factor affecting mortality and morbidity in bacterial meningitis. 1, 2
Immediate Management (First 30-60 Minutes)
Empiric Antibiotic Therapy
- Administer antibiotics within 30 minutes of arrival, ideally before lumbar puncture if any delay is anticipated 1, 2, 3
- Do not wait for imaging or lumbar puncture results if bacterial meningitis is suspected 3, 4
- The average time to antibiotics in confirmed bacterial meningitis cases is 136 minutes (range 0-340 minutes), but earlier administration significantly improves outcomes 2
Antibiotic Selection
- Ceftriaxone 2 grams IV is the cornerstone of empiric therapy for adults 5
- Administer over 30 minutes in adults (60 minutes in neonates) 5
- Maximum daily dose should not exceed 4 grams 5
Adjunctive Corticosteroid Therapy
- Administer dexamethasone before or at the time of antibiotic initiation to reduce mortality and morbidity 3
- This should be given to both children and adults with suspected bacterial meningitis 3
Infection Control Precautions
Droplet Precautions
- Implement droplet precautions immediately for suspected meningococcal meningitis 3
- Healthcare workers should wear surgical masks when within 3 feet of the patient
- Place patient in private room when possible
Chemoprophylaxis for Close Contacts
- Identify and treat close contacts promptly to prevent secondary cases 3
- Close contacts include dormitory roommates, intimate contacts, and those with direct exposure to oral secretions 3
- College freshmen living in dormitories are at modestly increased risk (5.1/100,000) compared to non-dormitory students 6
Diagnostic Approach
Lumbar Puncture Timing
- Perform lumbar puncture as soon as possible, but do not delay antibiotics if LP cannot be done immediately 3, 4
- If LP is delayed beyond antibiotic administration, cerebrospinal fluid analysis may still provide diagnostic information 4
Imaging Considerations
- Do not routinely obtain head CT before LP unless specific contraindications exist (focal neurological deficits, papilledema, altered consciousness, immunocompromised state) 2
- 60% of patients undergo brain imaging before LP, but this delays treatment unnecessarily in most cases 2
Blood Cultures
- Obtain blood cultures before antibiotics when possible, but do not delay treatment 4
Critical Clinical Recognition
Key Symptoms to Assess
- Classic triad: headache, fever, and neck stiffness (though often incomplete) 4
- Altered mental status
- Photophobia
- Rash (particularly petechial or purpuric in meningococcal disease)
Common Pitfalls
- Atypical presentations and complex medical histories lead to delayed treatment 2
- Kernig and Brudzinski signs have variable sensitivity and specificity—do not rely on these alone 3
- Patients with pneumococcal meningitis and typical symptoms receive earlier treatment, while those with atypical presentations are often treated late 2
College-Specific Considerations
Risk Stratification
- Freshmen living in dormitories have the highest risk among college students (5.1/100,000) 6
- This rate is higher than any age group except children <2 years 6
- Non-dormitory college students have rates similar to the general population (0.7/100,000) 6
Vaccination Status
- Assess meningococcal vaccination history 6
- Even vaccinated students remain at some risk as vaccine efficacy is <100% and provides no protection against serogroup B 6
Airway and Hemodynamic Management
- Maintain airway patency and normotension as early priorities 4
- Bacterial meningitis can rapidly progress to septic shock and respiratory failure 4
- Monitor closely for deterioration requiring intensive care 7