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The management of patients with aseptic meningitis is complicated by its diverse origins. If there is any suspicion of bacterial meningitis (immunosuppressed, at the extremes of age, previously received antibiotics, indeterminate CSF findings), there should be a low threshold for empiric antibiotics. Algorithms and nomograms have been studied and validated in one report, but practitioners should use their clinical judgment. Studies of patients with bacterial meningitis have shown that a delay in antiobiotic therapy is associated with adverse clinical outcome.
A complete history is critical and should focus on symptoms, preceding antibiotic treatment, travel and exposures, HIV risk factors, and recent medication use. Physical examination may show specific findings, such as a rash, neurologic deficits, or changes in cognition. Diagnostic tests, as discussed earlier, should be performed based on the patient’s history, physical findings, and, possibly, geographic locations.
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