Abstract

Acute meningitis is a potentially life-threatening neurological emergency which requires rapid diagnosis and early administration of appropriate empirical therapy. The compliance regarding empirical treatment of acute meningitis to the Barts and the London Trust (BLT) guidelines was assessed along with the use of corticosteroids. A retrospective audit for the time period of 1st January, 2008 to 21st May, 2009 was carried out in order to determine the level of compliance to the Trust guidelines in empirical treatment and the use of corticosteroids in acute meningitis. Patients were identified from cerebrospinal fluid specimens sent to the Microbiology Department from five wards in the BLT. This project's primary outcome is the extent to which prescribers follow current Trust guidelines regarding empirical antimicrobial therapy of community acquired meningitis/encephalitis and the extent to which corticosteroids are prescribed as adjuvant treatment. Twenty nine patients with suspected meningitis were identified. Eighty-nine percent of patients were initiated on appropriate antibiotics in accordance with Trust guidelines and 79% of patients on antiviral agents accordingly. When all elements of guideline compliance was assessed (antimicrobial choice, dose, time of administration etc), compliance fell to 38%. Empirical treatment was delayed for more than 6 h from admission in 30% of patients receiving antibiotics and 47% of patients receiving antivirals. Corticosteroids were not used. After identifying fairly low level of compliance, a suitable strategy for the improvement has to be developed. The place of corticosteroid therapy for the treatment of meningitis will be more specific.

Key words: Meningitis, antimicrobial agents, hospital, corticosteroids.