Lumbar Puncture Before CT in Patients with Bacterial Meningitis

An LP-first strategy was associated with less mortality and more favorable outcomes.

For patients suspected of having bacterial meningitis, Infectious Diseases Society of America guidelines recommend antibiotics first, followed by computed tomography (CT), followed by lumbar puncture (LP). This recommendation is based on findings that delayed antibiotic treatment confers increased risk of mortality and unfavorable outcomes, and fear that performing LP before CT could precipitate brain herniation in patients with mass effect. In contrast, Swedish guidelines recommend LP first. This approach reflects skepticism that LP is a cause of herniation, given the weak evidence for the theory. To determine whether outcomes were better or worse with an LP-first strategy, these investigators reviewed registry data for 815 patients diagno…

Reviewing Author

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Lumbar Puncture Before CT in Patients with Bacterial Meningitis

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Reviewing Author